Provider Demographics
NPI:1659568590
Name:PATRICK HENRY MEDICAL LLC
Entity Type:Organization
Organization Name:PATRICK HENRY MEDICAL LLC
Other - Org Name:BREATH OF LIFE
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 907
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75091-0907
Mailing Address - Country:US
Mailing Address - Phone:903-893-1301
Mailing Address - Fax:903-893-1437
Practice Address - Street 1:1708 BAKER RD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2473
Practice Address - Country:US
Practice Address - Phone:903-893-1301
Practice Address - Fax:903-893-1437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0099275332B00000X
332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1981532-02Medicaid
TX1981532-02Medicaid