Provider Demographics
NPI:1376525147
Name:BREAST CARE CENTER, P.C.
Entity Type:Organization
Organization Name:BREAST CARE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-265-7966
Mailing Address - Street 1:910 ADAMS ST SE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3730
Mailing Address - Country:US
Mailing Address - Phone:256-265-7966
Mailing Address - Fax:256-265-7965
Practice Address - Street 1:910 ADAMS ST SE
Practice Address - Street 2:SUITE 130
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3730
Practice Address - Country:US
Practice Address - Phone:256-265-7966
Practice Address - Fax:256-265-7965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00016874208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALF38407Medicare UPIN
AL51517603Medicare ID - Type Unspecified