Provider Demographics
NPI:1174581854
Name:REGIONAL ALLERGY & ASTHMA CENTER, PC
Entity type:Organization
Organization Name:REGIONAL ALLERGY & ASTHMA CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BIILING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOYLE
Authorized Official - Middle Name:EMANUEL
Authorized Official - Last Name:VARVEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:423-246-6445
Mailing Address - Street 1:#8 SHERIDAN SQUARE
Mailing Address - Street 2:ST 201
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660
Mailing Address - Country:US
Mailing Address - Phone:423-246-6445
Mailing Address - Fax:423-246-8240
Practice Address - Street 1:#8 SHERIDAN SQUARE
Practice Address - Street 2:ST 201
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660
Practice Address - Country:US
Practice Address - Phone:423-246-6445
Practice Address - Fax:423-246-8240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3713985Medicaid
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