Allergy Asthma and Immunology Associates of TH LLC
Organization Active NPI Specialist · Terre Haute, IN
NPI 1295934065 · NPPES record last updated Nov 8, 2016
Key facts
- NPI
- 1295934065
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- License
- 01040096 (IN)
- Legal business name
- ALLERGY ASTHMA AND IMMUNOLOGY ASSOCIATES OF TH LLC
- Practice address
- 4779 S 7TH St
Terre Haute, IN 47802-4559 - Phone
- (812) 234-2016
- Fax
- (812) 234-2700
- NPI assigned
- Jul 12, 2007
- Organization subpart
- No
Authorized official
- Name
- Nagarjuna R Pongugoti, MD
- Title
- MD
- Phone
- (812) 234-2016
Practitioners 3
-
Nagarjuna R Ponugoti, M.D
-
Rao Ivaturi, PH.D, CNS
-
Indira Ivaturi, LIFESTYLE COACH
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111123000589 | IN | Part B Supplier - Clinic/Group Practice | 1355515578 |
Receives reassigned benefits from 1 practitioner Practice locations: Terre Haute, IN |
National Provider Directory
Locations
4779 S 7th St
Terre Haute, IN 47802
Phone (812) 234-2016
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | 01040096 | IN | Yes |
Addresses
Primary practice location
4779 S 7TH St
Terre Haute, IN 47802-4559
Mailing address
4779 S 7TH St
Terre Haute, IN 47802-4559
Phone (812) 234-2016
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100252770A | Medicaid | IN |
Other providers in Terre Haute, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 8, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.