Healthcare Provider Details

I. General information

NPI: 1174642037
Provider Name (Legal Business Name): ALLERVIE HEALTH TEXAS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 09/02/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3502 22ND ST
LUBBOCK TX
79410-1308
US

IV. Provider business mailing address

3502 22ND ST
LUBBOCK TX
79410-1308
US

V. Phone/Fax

Practice location:
  • Phone: 806-799-4192
  • Fax: 806-799-6299
Mailing address:
  • Phone: 806-799-4192
  • Fax: 806-799-6299

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: SAMUEL ALTMAN
Title or Position: REVENUE INTEGRITY ADMINISTRATOR
Credential:
Phone: 469-209-8355