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General NPI Number Information
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NPI Number | 1558641647
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Entity Type | Organization
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Legal Business Name | MI2 VENTURES, LLC
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Dates
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Enumeration Date | 08/22/2011
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Last Update Date | 06/29/2012
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Provider Practice Location Address
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Address Line | 11615 ANGUS RD SUITE 109
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City | AUSTIN
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State | TX
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Zip | 78759-4078
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Country | US
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Telephone | 512-276-2135
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Fax | 512-276-2397
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Provider Business Mailing Address
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Address Line | 11615 ANGUS RD SUITE 109
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City | AUSTIN
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State | TX
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Zip | 78759-4078
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Country | US
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Telephone | 512-427-6213
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ADMINISTRATOR
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Name | MR. STEPHEN MARK ONDERKO
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Credential |
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Telephone | 512-276-2135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 014512
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License Number State | TX
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