Provider Demographics
NPI:1952571739
Name:GARDNER IMMUNIZATION CLINIC
Entity Type:Organization
Organization Name:GARDNER IMMUNIZATION CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:BOYAJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-856-8106
Mailing Address - Street 1:131 E MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-1309
Mailing Address - Country:US
Mailing Address - Phone:913-856-8106
Mailing Address - Fax:913-856-8802
Practice Address - Street 1:131 E MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-1309
Practice Address - Country:US
Practice Address - Phone:913-856-8106
Practice Address - Fax:913-856-8802
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOYAJIAN,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty