Provider Demographics
NPI:1114335775
Name:MILLENNIUM PHYSICIANS ASSOCIATON, PLLC
Entity Type:Organization
Organization Name:MILLENNIUM PHYSICIANS ASSOCIATON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOLLOY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:281-358-2850
Mailing Address - Street 1:22710 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-6008
Mailing Address - Country:US
Mailing Address - Phone:281-312-8560
Mailing Address - Fax:281-312-8561
Practice Address - Street 1:22710 PROFESSIONAL DR
Practice Address - Street 2:SUITE 203
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-6008
Practice Address - Country:US
Practice Address - Phone:281-312-8530
Practice Address - Fax:281-312-8532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125859363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty