Provider Demographics
NPI:1790037505
Name:ALLERGY AND ASTHMA CENTER OF COLORADO
Entity Type:Organization
Organization Name:ALLERGY AND ASTHMA CENTER OF COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-969-8920
Mailing Address - Street 1:400 S MCCASLIN BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9731
Mailing Address - Country:US
Mailing Address - Phone:720-890-9904
Mailing Address - Fax:720-890-1440
Practice Address - Street 1:400 S MCCASLIN BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9731
Practice Address - Country:US
Practice Address - Phone:720-890-9904
Practice Address - Fax:720-890-1440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38190174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty