Mimi'S
Exclusive Provider Organization in Austin, TX. Organization (NPI-2).
NPI number1063661809
StatusActive
Last updated in NPPESSep 17, 2008
Details
- NPI
- 1063661809
- Entity type
- Organization (NPI-2)
- Legal business name
- Mimi'S
- Organization subpart
- No
- Enumeration date
- Sep 17, 2008
- Last updated
- Sep 17, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 302F00000X | Exclusive Provider Organization | – | – | Yes |
Practice location
12636 Research BlvdSuite C 109
Austin, TX 78759-2200
Phone 512-470-5943 · Fax 512-231-1182
Mailing address
12636 Research BlvdSuite C 109
Austin, TX 78759-2200
Phone 512-470-5943 · Fax 512-231-1182
Authorized official
Pat Canter Brenner
Owner/Operator
5124705943
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All 6 Exclusive Provider Organization providers in Austin · All 34,666 providers in Austin
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