Provider Demographics
NPI:1497038137
Name:MINT PHYSICIAN STAFFING
Entity Type:Organization
Organization Name:MINT PHYSICIAN STAFFING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-541-1177
Mailing Address - Street 1:4031 REGAL STONE LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-7117
Mailing Address - Country:US
Mailing Address - Phone:832-618-9310
Mailing Address - Fax:281-778-0923
Practice Address - Street 1:4031 REGAL STONE LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-7117
Practice Address - Country:US
Practice Address - Phone:832-618-9310
Practice Address - Fax:281-778-0923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX400101070552304251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based