Provider Demographics
NPI:1457423550
Name:ALLERGY & IMMUNOLOGY, PLC
Entity Type:Organization
Organization Name:ALLERGY & IMMUNOLOGY, PLC
Other - Org Name:ASTHMA & ALLERGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:CALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-343-7331
Mailing Address - Street 1:1505 FRANKLIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-5206
Mailing Address - Country:US
Mailing Address - Phone:540-343-7331
Mailing Address - Fax:
Practice Address - Street 1:1505 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-5206
Practice Address - Country:US
Practice Address - Phone:540-343-7331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010338172207K00000X
207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05321Medicare ID - Type Unspecified