Provider Demographics
NPI:1992015465
Name:LONE STAR ALLERGY, ASTHMA, AND IMMUNOLOGY
Entity Type:Organization
Organization Name:LONE STAR ALLERGY, ASTHMA, AND IMMUNOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUDITA
Authorized Official - Middle Name:KIRIT
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-810-9800
Mailing Address - Street 1:800 8TH AVE
Mailing Address - Street 2:SUITE 324
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2601
Mailing Address - Country:US
Mailing Address - Phone:817-810-9800
Mailing Address - Fax:817-840-6403
Practice Address - Street 1:800 8TH AVE
Practice Address - Street 2:SUITE 323
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2601
Practice Address - Country:US
Practice Address - Phone:817-810-9800
Practice Address - Fax:817-840-6403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2791261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB144884Medicare UPIN