1477663797 NPI number — MIRACLE DURABLE MEDICAL EQUIPMENT INC

Table of content: (NPI 1477663797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477663797 NPI number — MIRACLE DURABLE MEDICAL EQUIPMENT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIRACLE DURABLE MEDICAL EQUIPMENT INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BREATH OF LIFE SLEEP AND RESPIRATORY CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477663797
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1395
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHERMAN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75091-1395
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-924-3900
Provider Business Mailing Address Fax Number:
580-924-3902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 W. EVERGREEN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURANT
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-924-3900
Provider Business Practice Location Address Fax Number:
580-924-3902
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOE
Authorized Official First Name:
HENRY
Authorized Official Middle Name:
BLUME
Authorized Official Title or Position:
CEO OWNER
Authorized Official Telephone Number:
903-893-1301

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0064720 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 27-5-3314 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200493700A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 153613801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 531794 . This is a "BC/BS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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