Provider Demographics
NPI:1730193582
Name:ACCREDITED ASTHMA & ALLERGY CARE PSC
Entity type:Organization
Organization Name:ACCREDITED ASTHMA & ALLERGY CARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-895-3330
Mailing Address - Street 1:1009B DUPONT SQ N
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4612
Mailing Address - Country:US
Mailing Address - Phone:502-895-3330
Mailing Address - Fax:502-895-3356
Practice Address - Street 1:1009B DUPONT SQ N
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4612
Practice Address - Country:US
Practice Address - Phone:502-895-3330
Practice Address - Fax:502-895-3356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY030004050OtherRAILROAD MEDICARE
KY64129356Medicaid
KY030004050OtherRAILROAD MEDICARE