=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376525147
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BREAST CARE CENTER, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 910 ADAMS ST SE SUITE 130
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35801-3730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-265-7966
-----------------------------------------------------
Fax | 256-265-7965
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 910 ADAMS ST SE SUITE 130
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35801-3730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-265-7966
-----------------------------------------------------
Fax | 256-265-7965
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RICHARD P. RICHARDSON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 256-265-7966
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 00016874
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------