Provider Demographics
NPI:1093818411
Name:CODY L. MIHILLS MD PA
Entity Type:Organization
Organization Name:CODY L. MIHILLS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CODY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MIHILLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-310-0421
Mailing Address - Street 1:1001 W. SOUTHLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092
Mailing Address - Country:US
Mailing Address - Phone:817-310-0421
Mailing Address - Fax:817-310-5870
Practice Address - Street 1:1001 W. SOUTHLAKE BLVD.
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092
Practice Address - Country:US
Practice Address - Phone:817-310-0421
Practice Address - Fax:817-310-5870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5053207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H72919Medicare UPIN
TX8F4659Medicare PIN