Provider Demographics
NPI:1881201754
Name:WILLIAM STORMS ALLERGY CLINIC PC
Entity Type:Organization
Organization Name:WILLIAM STORMS ALLERGY CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-548-0988
Mailing Address - Street 1:5929 BALCONES DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4280
Mailing Address - Country:US
Mailing Address - Phone:125-501-8005
Mailing Address - Fax:855-828-0878
Practice Address - Street 1:900 INDIANA AVE STE C
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3767
Practice Address - Country:US
Practice Address - Phone:719-955-6000
Practice Address - Fax:855-828-0878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO50227876Medicaid