Provider Demographics
NPI:1881707636
Name:ALLERGY AND ASTHMA ASSOCIATES OF SOUTHWEST VIRGINIA INC
Entity type:Organization
Organization Name:ALLERGY AND ASTHMA ASSOCIATES OF SOUTHWEST VIRGINIA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-382-1165
Mailing Address - Street 1:2955 MARKET ST
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6575
Mailing Address - Country:US
Mailing Address - Phone:540-382-1165
Mailing Address - Fax:
Practice Address - Street 1:2955 MARKET ST
Practice Address - Street 2:SUITE B-1
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6575
Practice Address - Country:US
Practice Address - Phone:540-382-1165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207K00000X
VA0101-045194207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Not Answered207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE49907Medicare UPIN
VAC09378Medicare ID - Type Unspecified