Allergy & Asthma Care of Waco, PA
Organization Active NPI Specialist · Waco, TX
NPI 1487847463 · NPPES record last updated Jul 28, 2021
Key facts
- NPI
- 1487847463
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- License
- G1639 (TX)
- Legal business name
- ALLERGY & ASTHMA CARE OF WACO, PA
- Practice address
- 221 Jewell Dr
Waco, TX 76712-6630 - Phone
- (254) 753-3646
- Fax
- (254) 753-1411
- NPI assigned
- Aug 22, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Pramila K. Daftary, M.D.
- Title
- President
- Phone
- (254) 753-3646
Practitioners 7
-
Pramila K. Daftary, M.D.
-
Dustin Fowler, D.O.
-
Leslie Cernosek Muenzler, NP-C
-
Katharine Lorraine Vogelaar, DNP, FNP-C
-
Julie A Tesch, FNP
-
Frederick Flint Herman, M.D.
-
Patricia Allison Tatum, NURSE PRACTITIONER
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D1078060 | Allergy & Asthma Care of Waco | Certificate of waiver | Dec 27, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090617000392 | TX | Part B Supplier - Clinic/Group Practice | 9335299130 |
Receives reassigned benefits from 3 practitioners Practice locations: Waco, TX |
National Provider Directory
Locations
221 Jewell Dr
Waco, TX 76712
Phone (254) 753-3646
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | G1639 | TX | Yes |
Addresses
Primary practice location
221 Jewell Dr
Waco, TX 76712-6630
Mailing address
221 Jewell Dr
Waco, TX 76712-6630
Phone (254) 753-3646
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 080984001 | Medicaid | TX |
Other providers in Waco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 28, 2021. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.