MEDICARE: MOBILE ALLERGY AND URGENT CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207KA0200X	Allergy Physician

General Provider Information

NPI Number	:	1841821659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE ALLERGY AND URGENT CARE LLC

Provider Business Mailing Address
First Line	:	3260 LEXINGTON RD
Second Line	:
City	:	NICHOLASVILLE
State	:	KY
Zip	:	40356-9798
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3260 LEXINGTON RD
Second Line	:
City	:	NICHOLASVILLE
State	:	KY
Zip	:	40356-9798
Country	:	US
Telephone Number	:	720-771-4015
Fax Number	:

Authorized Official
Title or Position	:	APRN
Name	:	DANIEL LONG
Credential	:
Telephone Number	:	720-771-4015

Provider Enumeration Date	:	01/30/2020
Last Update Date	:	01/15/2021

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