Provider Demographics
NPI:1639368970
Name:JASON C MILLER DPM PA
Entity Type:Organization
Organization Name:JASON C MILLER DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:E
Authorized Official - Last Name:PENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-348-2166
Mailing Address - Street 1:25511 BUDDE RD STE 3701
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-4173
Mailing Address - Country:US
Mailing Address - Phone:281-348-2166
Mailing Address - Fax:281-358-2153
Practice Address - Street 1:1330 KINGWOOD DR STE 200
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3038
Practice Address - Country:US
Practice Address - Phone:281-348-2166
Practice Address - Fax:281-358-2153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1555213E00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146769804Medicaid
TX177385501Medicaid
TX00609ZMedicare PIN
TX146769804Medicaid
TX5541990001Medicare NSC
TXDE1381Medicare PIN
TX8F1314Medicare PIN
TX5541990001Medicare PIN
TXP00274104Medicare PIN