Provider Demographics
NPI:1801374228
Name:CAPITOL BREATHE FREE SINUS & ALLERGY CENTERS
Entity Type:Organization
Organization Name:CAPITOL BREATHE FREE SINUS & ALLERGY CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-683-1727
Mailing Address - Street 1:2021 K ST NW STE 600
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-1051
Mailing Address - Country:US
Mailing Address - Phone:202-888-8365
Mailing Address - Fax:833-200-5844
Practice Address - Street 1:2021 K ST NW STE 600
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006
Practice Address - Country:US
Practice Address - Phone:202-888-8365
Practice Address - Fax:833-200-5844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC025957016Medicaid
VA1518008580Medicaid