Healthcare Provider Details

I. General information

NPI: 1417034695
Provider Name (Legal Business Name): ALLERGY, ASTHMA & SINUS CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 LANDMARK PARKWAY DR STE 207
SAINT LOUIS MO
63127-1665
US

IV. Provider business mailing address

9701 LANDMARK PARKWAY DR STE 207
SAINT LOUIS MO
63127-1665
US

V. Phone/Fax

Practice location:
  • Phone: 314-849-8700
  • Fax:
Mailing address:
  • Phone: 314-849-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberR5G81
License Number StateMO

VIII. Authorized Official

Name: MICHAEL R BORTS
Title or Position: PRESIDENT
Credential: MD
Phone: 314-849-8700