=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972676633
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. VIRGINIA M MILLS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2006
-----------------------------------------------------
Last Update Date | 06/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11023 NORTHPOINTE BLVD
-----------------------------------------------------
City | TOMBALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77375-2433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-919-2190
-----------------------------------------------------
Fax | 877-288-1193
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11023 NORTHPOINTE BLVD
-----------------------------------------------------
City | TOMBALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77375-2433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-919-2190
-----------------------------------------------------
Fax | 877-288-1193
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | J2210
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------