Provider Demographics
NPI:1275275349
Name:BREATHE AIRWAY MERIDIAN LLC
Entity Type:Organization
Organization Name:BREATHE AIRWAY MERIDIAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCRAE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:208-484-5702
Mailing Address - Street 1:1067 S WELLS ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8596
Mailing Address - Country:US
Mailing Address - Phone:208-484-5702
Mailing Address - Fax:
Practice Address - Street 1:1067 S WELLS ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8596
Practice Address - Country:US
Practice Address - Phone:208-484-5702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-10
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty