Provider Demographics
NPI:1447623848
Name:ADVANCED BREATH DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:ADVANCED BREATH DIAGNOSTICS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-376-5464
Mailing Address - Street 1:105 WESTPARK DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5319
Mailing Address - Country:US
Mailing Address - Phone:615-376-5464
Mailing Address - Fax:615-376-6384
Practice Address - Street 1:105 WESTPARK DR
Practice Address - Street 2:SUITE 150
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5319
Practice Address - Country:US
Practice Address - Phone:615-376-5464
Practice Address - Fax:615-376-6384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN44D0940011OtherCLIA