Provider Demographics
NPI:1265710156
Name:ALLERGY & ASTHMA CARE OF IN
Entity type:Organization
Organization Name:ALLERGY & ASTHMA CARE OF IN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRICK
Authorized Official - Middle Name:P
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-708-2839
Mailing Address - Street 1:1815 N CAPITOL AVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1288
Mailing Address - Country:US
Mailing Address - Phone:317-708-2839
Mailing Address - Fax:317-708-2877
Practice Address - Street 1:1815 N CAPITOL AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1288
Practice Address - Country:US
Practice Address - Phone:317-925-3533
Practice Address - Fax:317-924-5624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28168864A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty