Healthcare Provider Details

I. General information

NPI: 1780629535
Provider Name (Legal Business Name): ALLERVIE HEALTH PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 BROOKWOOD BLVD
BIRMINGHAM AL
35209-6802
US

IV. Provider business mailing address

504 BROOKWOOD BLVD
BIRMINGHAM AL
35209-6802
US

V. Phone/Fax

Practice location:
  • Phone: 205-871-9661
  • Fax: 205-870-1621
Mailing address:
  • Phone: 205-871-9661
  • Fax: 205-870-1621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: LILY FLYNN
Title or Position: RCM BUSINESS PARTNER
Credential:
Phone: 469-209-8355