| Name: | Alabama Allergy & Asthma Care, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 04 Nov 2015 (9 years ago) |
| Entity Number: | 000-348-482 |
| Register Number: | 000348482 |
| County: | Madison |
| Place of Formation: | Madison County |
| Registered Office Street Address: | 101 WESTOVER CIRCLE STE CMADISON, AL 35758 |
| Registered Office Street Address ZIP Code: | 35758 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346695541 | 2016-04-26 | 2016-04-26 | 101 WESTOVER CIR, SUITE C, MADISON, AL, 357584900, US | 101 WESTOVER CIR, SUITE C, MADISON, AL, 357584900, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 256-890-0331 |
| Fax | 2563251189 |
Authorized person
| Name | DR. SHIVA KRISHNA |
| Role | PHYSICIAN |
| Phone | 2568900331 |
Taxonomy
| Taxonomy Code | 207K00000X - Allergy & Immunology Physician |
| License Number | 00025205 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | GROUP PTAN GIVEN BY MEDICARE |
| Number | 10270G0894 |
| Issuer | PTAN GIVEN BY MEDICARE |
| Number | 102I038525 |
| Issuer | MEDICAID |
| Number | 182367 |
| State | AL |
| Name | Role |
|---|---|
| KRISHNA, SHIVA S | Agent |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
