Provider Demographics
NPI:1114256864
Name:MILLER, LUCILLE
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:1HEARTBEAT
Other - Middle Name:TRANSPORTATION
Other - Last Name:SERVICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:21531 FALVEL MISTY DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-2513
Mailing Address - Country:US
Mailing Address - Phone:210-488-1834
Mailing Address - Fax:210-468-0628
Practice Address - Street 1:8034 CULEBRA RD
Practice Address - Street 2:STE 109
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1882
Practice Address - Country:US
Practice Address - Phone:210-488-1834
Practice Address - Fax:210-468-0628
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2012-12-27
Deactivation Date:2010-07-27
Deactivation Code:
Reactivation Date:2012-05-17
Provider Licenses
StateLicense IDTaxonomies
TX1000357341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188723OtherSUPERIOR HEALTH PLAN
TX1811298219OtherBCBS
TXAM1271OtherBCBS OF TEXAS
TX188723OtherSUPERIOR HEALTH PLAN