MEDICARE: MILLERS QUALITY DELIVERY SERVICE

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	172A00000X	Driver

General Provider Information

NPI Number	:	1295368538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLERS QUALITY DELIVERY SERVICE

Provider Business Mailing Address
First Line	:	483 LAUREL LN APT 210
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-6185
Country	:	US
Telephone Number	:	719-551-7837
Fax Number	:

Provider Business Practice Location Address
First Line	:	483 LAUREL LN APT 210
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-6185
Country	:	US
Telephone Number	:	719-551-7837
Fax Number	:

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	MR. WENDELL JOSEPH MILLER
Credential	:
Telephone Number	:	719-551-7837

Provider Enumeration Date	:	02/14/2020
Last Update Date	:	02/14/2020

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