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General NPI Number Information
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NPI Number | 1730359340
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Entity Type | Organization
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Legal Business Name | KIRKSVILLE ALLERGY AND ASTHMA, LLC
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 10/01/2013
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Provider Practice Location Address
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Address Line | 610 ROSEWOOD DR
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City | KIRKSVILLE
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State | MO
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Zip | 63501-2477
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Country | US
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Telephone | 660-627-2553
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Fax | 660-665-0448
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Provider Business Mailing Address
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Address Line | 610 ROSEWOOD DR
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City | KIRKSVILLE
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State | MO
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Zip | 63501-2477
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Country | US
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Telephone | 660-627-2553
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Fax | 660-665-0448
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | MRS. TRACY TALTON
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Credential |
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Telephone | 660-627-2553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | 19139861
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License Number State | MO
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