Provider Demographics
NPI:1700138781
Name:BREATHEAMERICA SHREVEPORT INC
Entity Type:Organization
Organization Name:BREATHEAMERICA SHREVEPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP MANAGED CARE
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-7122
Mailing Address - Street 1:463 ASHLEY RIDGE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7231
Mailing Address - Country:US
Mailing Address - Phone:318-221-3585
Mailing Address - Fax:318-227-9094
Practice Address - Street 1:463 ASHLEY RIDGE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7231
Practice Address - Country:US
Practice Address - Phone:318-221-3585
Practice Address - Fax:318-227-9094
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BREATHEAMERICA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-15
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA009735207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty