Provider Demographics
NPI:1417986647
Name:FORT WORTH BREATHING CLUB INC
Entity Type:Organization
Organization Name:FORT WORTH BREATHING CLUB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRABTREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-386-5111
Mailing Address - Street 1:3401-B DENTON HWY.
Mailing Address - Street 2:
Mailing Address - City:HALTOM CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76117-3235
Mailing Address - Country:US
Mailing Address - Phone:817-386-5111
Mailing Address - Fax:817-386-4727
Practice Address - Street 1:3401-B DENTON HWY
Practice Address - Street 2:
Practice Address - City:HALTOM CITY
Practice Address - State:TX
Practice Address - Zip Code:76117-3235
Practice Address - Country:US
Practice Address - Phone:817-386-5111
Practice Address - Fax:817-386-4727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0074593332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX016443601Medicaid
TX010634601Medicaid
TX016443601Medicaid