Provider Demographics
NPI:1740494079
Name:ALLERGY ASSOCIATES PC
Entity type:Organization
Organization Name:ALLERGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:PETRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-378-3131
Mailing Address - Street 1:815 SCHNIER STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-2619
Mailing Address - Country:US
Mailing Address - Phone:812-378-3131
Mailing Address - Fax:812-379-9251
Practice Address - Street 1:815 SCHNIER STREET
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-2619
Practice Address - Country:US
Practice Address - Phone:812-378-3131
Practice Address - Fax:812-379-9251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100052300Medicaid
IN591190Medicare PIN
IN100052300Medicaid
IN702060Medicare PIN
IN143490Medicare PIN