Provider Demographics
NPI:1972782712
Name:COMMUNITY ALLERGY & ASTHMA PSC
Entity Type:Organization
Organization Name:COMMUNITY ALLERGY & ASTHMA PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:B
Authorized Official - Last Name:MASHBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-234-8852
Mailing Address - Street 1:106 LADISH RD
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-1564
Mailing Address - Country:US
Mailing Address - Phone:859-234-8852
Mailing Address - Fax:859-234-8859
Practice Address - Street 1:106 LADISH RD
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-1564
Practice Address - Country:US
Practice Address - Phone:859-234-8852
Practice Address - Fax:859-234-8859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36048207K00000X
KYPA1557363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7340Medicare PIN