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General NPI Number Information
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NPI Number | 1992294151
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Entity Type | Organization
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Legal Business Name | MIRACLES AND MANE
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Dates
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Enumeration Date | 05/03/2018
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Last Update Date | 05/03/2018
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Provider Practice Location Address
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Address Line | 4524 S W S YOUNG DR STE 102
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City | KILLEEN
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State | TX
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Zip | 76542-5888
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Country | US
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Telephone | 254-702-2079
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Fax |
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Provider Business Mailing Address
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Address Line | 4524 S W S YOUNG DR STE 102
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City | KILLEEN
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State | TX
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Zip | 76542-5888
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Country | US
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Telephone | 254-702-2079
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE ASSISTANT OF OPERATIONS
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Name | ANNSONIA LOUISE THOMAS
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Credential |
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Telephone | 254-312-7012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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