Provider Demographics
NPI:1700076155
Name:ALLERGY & ASTHMA CENTER PC MD
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA CENTER PC MD
Other - Org Name:DONNA WYCHE-BASHOR MD PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WYCHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-282-2822
Mailing Address - Street 1:308 SUNSET DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2489
Mailing Address - Country:US
Mailing Address - Phone:423-282-2822
Mailing Address - Fax:423-282-5492
Practice Address - Street 1:308 SUNSET DR
Practice Address - Street 2:SUITE 1
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2489
Practice Address - Country:US
Practice Address - Phone:423-282-2822
Practice Address - Fax:423-282-5492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000020021207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4054578Medicaid
F03121Medicare UPIN
3714021Medicare PIN