Healthcare Provider Details

I. General information

NPI: 1639668791
Provider Name (Legal Business Name): AIRWAY BREATHING CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 05/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 OLD COLONY LN STE B
WILLIAMSBURG VA
23185-3801
US

IV. Provider business mailing address

28 RESEARCH DR STE A
HAMPTON VA
23666-1364
US

V. Phone/Fax

Practice location:
  • Phone: 757-826-2600
  • Fax: 757-826-9269
Mailing address:
  • Phone: 757-826-2600
  • Fax: 757-826-9269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0206009655
License Number StateVA

VIII. Authorized Official

Name: JUSTIN PATRICK MILLER
Title or Position: PRESIDENT
Credential:
Phone: 757-826-2600