Provider Demographics
NPI:1063460285
Name:BREATHERITE MEDICAL, INC.
Entity Type:Organization
Organization Name:BREATHERITE MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-639-8076
Mailing Address - Street 1:6800 HWY. US23 SOUTH
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-6800
Mailing Address - Country:US
Mailing Address - Phone:606-639-8223
Mailing Address - Fax:606-639-8233
Practice Address - Street 1:6800 HWY. US23 SOUTH
Practice Address - Street 2:SUITE 2
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-6800
Practice Address - Country:US
Practice Address - Phone:606-639-8223
Practice Address - Fax:606-639-8233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90009432Medicaid
KY5219550001Medicare ID - Type Unspecified