Provider Demographics
NPI:1053407197
Name:ALLERGY AND ASTHMA CENTER OF APPALACHIA, PLLC
Entity type:Organization
Organization Name:ALLERGY AND ASTHMA CENTER OF APPALACHIA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:606-433-0591
Mailing Address - Street 1:5425 N MAYO TRL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-2966
Mailing Address - Country:US
Mailing Address - Phone:606-433-0591
Mailing Address - Fax:606-433-0594
Practice Address - Street 1:5425 N MAYO TRL
Practice Address - Street 2:SUITE 101
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-2966
Practice Address - Country:US
Practice Address - Phone:606-433-0591
Practice Address - Fax:606-433-0594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37578207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20441212OtherTRICARE/CHAMPUS
KY11175801OtherCAQH
KY000000483090OtherBLUE CROSS BLUE SHIELD
KY64063340Medicaid
KY11175801OtherCAQH