Provider Demographics
NPI:1700322930
Name:BREATH OF LIFE MEDICAL
Entity Type:Organization
Organization Name:BREATH OF LIFE MEDICAL
Other - Org Name:MIRACLE DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-423-3830
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:972-423-3830
Mailing Address - Fax:903-893-1437
Practice Address - Street 1:208 W EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-4710
Practice Address - Country:US
Practice Address - Phone:580-924-3900
Practice Address - Fax:903-893-1437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4484920001Medicare NSC