Provider Demographics
NPI:1407861073
Name:BRET H MILLER MD PA ORTHOPAEDIC AND SPORTS MEDICINE SPECIALISTS OF WAC
Entity type:Organization
Organization Name:BRET H MILLER MD PA ORTHOPAEDIC AND SPORTS MEDICINE SPECIALISTS OF WAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:B
Authorized Official - Last Name:SZANTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-772-8677
Mailing Address - Street 1:PO BOX 21506
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-1506
Mailing Address - Country:US
Mailing Address - Phone:254-772-8677
Mailing Address - Fax:254-752-1511
Practice Address - Street 1:300 RICHLAND WEST CIR
Practice Address - Street 2:SUITE 1
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7934
Practice Address - Country:US
Practice Address - Phone:254-772-8677
Practice Address - Fax:254-752-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2608174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0062EMOtherBLUE CROSS BLUE SHIELD
TX0812653-01Medicaid
TX0812653-01Medicaid