Provider Demographics
NPI:1477663797
Name:MIRACLE DURABLE MEDICAL EQUIPMENT INC
Entity Type:Organization
Organization Name:MIRACLE DURABLE MEDICAL EQUIPMENT INC
Other - Org Name:BREATH OF LIFE SLEEP AND RESPIRATORY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:BLUME
Authorized Official - Last Name:LOE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:903-893-1301
Mailing Address - Street 1:PO BOX 1395
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75091-1395
Mailing Address - Country:US
Mailing Address - Phone:580-924-3900
Mailing Address - Fax:580-924-3902
Practice Address - Street 1:208 W. EVERGREEN STREET
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701
Practice Address - Country:US
Practice Address - Phone:580-924-3900
Practice Address - Fax:580-924-3902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0064720332B00000X
OK27-5-3314332B00000X
332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200493700AMedicaid
TX153613801Medicaid
TX531794OtherBC/BS OF TEXAS
TX153613801Medicaid
TX531794OtherBC/BS OF TEXAS