1154633055 NPI number — LUCILLE MILLER

Table of content: (NPI 1154633055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154633055 NPI number — LUCILLE MILLER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUCILLE MILLER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
1 HEARTBEAT TRANSPORTATION SERVICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154633055
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
10/18/2012
NPI Reactivation Date:
12/20/2012

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21531 FALVEL MISTY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77388-2513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-715-6087
Provider Business Mailing Address Fax Number:
210-468-0628

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8034 CULEBRA RD
Provider Second Line Business Practice Location Address:
STE 109
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78251-1882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-488-1834
Provider Business Practice Location Address Fax Number:
210-468-0628
Provider Enumeration Date:
07/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
LUCILLE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
832-715-6087

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1000357 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 219770901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 188723 . This is a "SUPERIOR HEALTH PLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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