Healthcare Provider Details

I. General information

NPI: 1265784342
Provider Name (Legal Business Name): BREATHEAMERICA, RICHMOND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2012
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CONCOURSE BLVD SUITE 100
GLEN ALLEN VA
23059-5640
US

IV. Provider business mailing address

1 BURTON HILLS BLVD SUITE 375
NASHVILLE TN
37215-6293
US

V. Phone/Fax

Practice location:
  • Phone: 804-968-4824
  • Fax: 804-968-4826
Mailing address:
  • Phone: 615-665-8775
  • Fax: 615-665-8776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number StateVA

VIII. Authorized Official

Name: MR. TIMOTHY JAMES MILLER
Title or Position: VP MANAGED CARE
Credential:
Phone: 615-665-7122