Contract Details
Ancillary Care Services
Facility name
Breath of Life Medical
Provider ID
P000005038
NPI
1659568590
Tax ID
260640090
Effective Date
4/1/2012
Last Updated
10/23/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1613 Texoma Parkway
Sherman, TX 75090
United States
County
Grayson
Phone
9038931301 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address