Healthcare Provider Details

I. General information

NPI: 1841821659
Provider Name (Legal Business Name): MOBILE ALLERGY AND URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 LEXINGTON RD
NICHOLASVILLE KY
40356-9798
US

IV. Provider business mailing address

3260 LEXINGTON RD
NICHOLASVILLE KY
40356-9798
US

V. Phone/Fax

Practice location:
  • Phone: 720-771-4015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL LONG
Title or Position: APRN
Credential:
Phone: 720-771-4015