Provider Demographics
NPI:1972760999
Name:MILBY CLINIC, P A
Entity type:Organization
Organization Name:MILBY CLINIC, P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:713-225-0463
Mailing Address - Street 1:5151 KATY FWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-2260
Mailing Address - Country:US
Mailing Address - Phone:713-225-0463
Mailing Address - Fax:
Practice Address - Street 1:5151 KATY FWY
Practice Address - Street 2:SUITE 130
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-2260
Practice Address - Country:US
Practice Address - Phone:713-225-0463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC19539Medicare UPIN