=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831294800
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLERGY AND ASTHMA CLINIC OF CENTRAL TEXAS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2006
-----------------------------------------------------
Last Update Date | 03/17/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 N MAYS ST STE 109
-----------------------------------------------------
City | ROUND ROCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78664-2166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-690-2800
-----------------------------------------------------
Fax | 254-690-5401
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 268945
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73126-8945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-388-1861
-----------------------------------------------------
Fax | 512-388-0373
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | DR. BRIAN MILLER
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 512-388-1861
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207K00000X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology Physician
-----------------------------------------------------
License Number | F4284
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------