MEDICARE: RICHARD MILBURN ACADEMY

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	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1376081042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD MILBURN ACADEMY

Provider Business Mailing Address
First Line	:	1263 TERMINAL LOOP RD
Second Line	:
City	:	MC QUEENEY
State	:	TX
Zip	:	78123-3341
Country	:	US
Telephone Number	:	830-557-6181
Fax Number	:

Provider Business Practice Location Address
First Line	:	1263 TERMINAL LOOP RD
Second Line	:
City	:	MC QUEENEY
State	:	TX
Zip	:	78123-3341
Country	:	US
Telephone Number	:	830-557-6181
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF SPECIAL EDUCATION
Name	:	ALETHEA PHILLIPS
Credential	:
Telephone Number	:	210-307-8582

Provider Enumeration Date	:	02/02/2017
Last Update Date	:	02/02/2017

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