Provider Demographics
NPI:1942307228
Name:CHARLES NKWO MILLER
Entity Type:Organization
Organization Name:CHARLES NKWO MILLER
Other - Org Name:CENTRAL TEXAS MEDICAL EQUIPMENT & SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DME
Authorized Official - Phone:512-451-9704
Mailing Address - Street 1:8212 GEORGIAN DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-5904
Mailing Address - Country:US
Mailing Address - Phone:512-451-9704
Mailing Address - Fax:512-451-9760
Practice Address - Street 1:8212 GEORGIAN DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-5904
Practice Address - Country:US
Practice Address - Phone:512-451-9704
Practice Address - Fax:512-451-9760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0082082332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1805608Medicaid