Provider Demographics
NPI:1770610883
Name:SURREAL BREATHING LLC
Entity type:Organization
Organization Name:SURREAL BREATHING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY-LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MULCAHY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MBA, BSN
Authorized Official - Phone:480-357-3904
Mailing Address - Street 1:9221 E BASELINE RD
Mailing Address - Street 2:SUITE A109-617
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-8310
Mailing Address - Country:US
Mailing Address - Phone:480-357-3904
Mailing Address - Fax:480-357-4639
Practice Address - Street 1:595 ORLEANS ST
Practice Address - Street 2:SUITE 822A
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3214
Practice Address - Country:US
Practice Address - Phone:409-543-1942
Practice Address - Fax:480-718-8220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5882250001Medicare NSC