Provider Demographics
NPI:1285667436
Name:MILTEN CLINIC INC
Entity type:Organization
Organization Name:MILTEN CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:NURSING
Authorized Official - Phone:832-955-1348
Mailing Address - Street 1:811 COOPER ST
Mailing Address - Street 2:
Mailing Address - City:BROOKSHIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77423
Mailing Address - Country:US
Mailing Address - Phone:832-955-1348
Mailing Address - Fax:832-955-1060
Practice Address - Street 1:811 COOPER RD
Practice Address - Street 2:
Practice Address - City:BROOKSHIRE
Practice Address - State:TX
Practice Address - Zip Code:77423-9320
Practice Address - Country:US
Practice Address - Phone:832-955-1348
Practice Address - Fax:832-955-1060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W595Medicare PIN