MEDICARE: MILTEN CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1285667436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILTEN CLINIC INC

Provider Business Mailing Address
First Line	:	811 COOPER ST
Second Line	:
City	:	BROOKSHIRE
State	:	TX
Zip	:	77423
Country	:	US
Telephone Number	:	832-955-1348
Fax Number	:	832-955-1060

Provider Business Practice Location Address
First Line	:	811 COOPER RD
Second Line	:
City	:	BROOKSHIRE
State	:	TX
Zip	:	77423-9320
Country	:	US
Telephone Number	:	832-955-1348
Fax Number	:	832-955-1060

Authorized Official
Title or Position	:	CORPORATE MANAGER
Name	:	RITA SMITH
Credential	:	NURSING
Telephone Number	:	832-955-1348

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	09/03/2009

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Directions to “MILTEN CLINIC INC ” Practice Location

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