Provider Demographics
NPI:1891799292
Name:MILLER BRACE CO., INC.
Entity Type:Organization
Organization Name:MILLER BRACE CO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:D
Authorized Official - Last Name:NEVIL
Authorized Official - Suffix:
Authorized Official - Credentials:LO
Authorized Official - Phone:214-824-4507
Mailing Address - Street 1:3902 GASTON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1511
Mailing Address - Country:US
Mailing Address - Phone:214-824-4507
Mailing Address - Fax:214-824-7553
Practice Address - Street 1:3902 GASTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1511
Practice Address - Country:US
Practice Address - Phone:214-824-4507
Practice Address - Fax:214-824-7553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000129335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0099202-01Medicaid
TX0099202-01Medicaid