Provider Demographics
NPI:1063661809
Name:MIMI'S
Entity Type:Organization
Organization Name:MIMI'S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:CANTER
Authorized Official - Last Name:BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-470-5943
Mailing Address - Street 1:12636 RESEARCH BLVD
Mailing Address - Street 2:SUITE C 109
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-2200
Mailing Address - Country:US
Mailing Address - Phone:512-470-5943
Mailing Address - Fax:512-231-1182
Practice Address - Street 1:12636 RESEARCH BLVD
Practice Address - Street 2:SUITE C 109
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-2200
Practice Address - Country:US
Practice Address - Phone:512-470-5943
Practice Address - Fax:512-231-1182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization