Provider Demographics
NPI:1992537856
Name:BREATHEWELL PULMONARY CLINIC LLC
Entity type:Organization
Organization Name:BREATHEWELL PULMONARY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:AMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-556-2742
Mailing Address - Street 1:9628 CHARLESBERG DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-1638
Mailing Address - Country:US
Mailing Address - Phone:813-419-3108
Mailing Address - Fax:813-482-0542
Practice Address - Street 1:3450 E FLETCHER AVE STE 260
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4697
Practice Address - Country:US
Practice Address - Phone:813-419-3108
Practice Address - Fax:813-482-0542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty