MEDICARE: WADE AUMILLER PHD PA-C

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	363AS0400X	Surgical Physician Assistant
2	363A00000X	Physician Assistant	PA11132	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	363AS0400X	OTHER		TAXONOMY CODE

General Provider Information

NPI Number	:	1194257139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WADE AUMILLER PHD PA-C

Provider Business Mailing Address
First Line	:	1001 N WALDROP DR STE 403
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76012-4703
Country	:	US
Telephone Number	:	817-701-4253
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 N WALDROP DR STE 403
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76012-4703
Country	:	US
Telephone Number	:	817-701-4253
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2017
Last Update Date	:	10/21/2025

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