Provider Demographics
NPI:1649660168
Name:MILLER MAC GROUP, LLC
Entity type:Organization
Organization Name:MILLER MAC GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SIVARAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-618-5600
Mailing Address - Street 1:5566 MAIN ST STE 210
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-3673
Mailing Address - Country:US
Mailing Address - Phone:214-618-5600
Mailing Address - Fax:214-618-7733
Practice Address - Street 1:300 S NOLEN DR STE 160
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-8054
Practice Address - Country:US
Practice Address - Phone:214-618-5600
Practice Address - Fax:214-618-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-04
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130212261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical