=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881899177
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THOROUGHBRED ALLERGY AND ASTHMA CENTER,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3292 EAGLE VIEW LN STE 150
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40509-1851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-263-1900
-----------------------------------------------------
Fax | 859-263-2726
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3292 EAGLE VIEW LN STE 150
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40509-1851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-263-1900
-----------------------------------------------------
Fax | 859-263-2726
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RODNEY M MANN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 859-263-1900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207K00000X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology Physician
-----------------------------------------------------
License Number | 28249
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------