Provider Demographics
NPI:1992294151
Name:MIRACLES AND MANE
Entity type:Organization
Organization Name:MIRACLES AND MANE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ANNSONIA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-312-7012
Mailing Address - Street 1:4524 S W S YOUNG DR STE 102
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-5888
Mailing Address - Country:US
Mailing Address - Phone:254-702-2079
Mailing Address - Fax:
Practice Address - Street 1:4524 S W S YOUNG DR STE 102
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-5888
Practice Address - Country:US
Practice Address - Phone:254-702-2079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies