=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114136561
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLEN ALLIED HEALTHCARE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 03/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 403 PRINCETON RD STE 1
-----------------------------------------------------
City | JOHNSON CITY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37601-2040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-283-9913
-----------------------------------------------------
Fax | 423-283-9908
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 403 PRINCETON RD STE 1
-----------------------------------------------------
City | JOHNSON CITY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37601-2040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-283-9913
-----------------------------------------------------
Fax | 423-283-9908
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | KAREN G HATHAWAY
-----------------------------------------------------
Credential | ANP-C
-----------------------------------------------------
Telephone | 423-283-9913
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 173000000X
-----------------------------------------------------
Taxonomy Name | Legal Medicine
-----------------------------------------------------
License Number | APN6312
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------