MEDICARE: FORT WORTH BREATHING CLUB INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)	0074593	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417986647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT WORTH BREATHING CLUB INC

Provider Business Mailing Address
First Line	:	3401-B DENTON HWY.
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76117-3235
Country	:	US
Telephone Number	:	817-386-5111
Fax Number	:	817-386-4727

Provider Business Practice Location Address
First Line	:	3401-B DENTON HWY
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76117-3235
Country	:	US
Telephone Number	:	817-386-5111
Fax Number	:	817-386-4727

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BARBARA J CRABTREE
Credential	:
Telephone Number	:	817-386-5111

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	05/19/2009

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