Provider Demographics
NPI:1831294800
Name:ALLERGY AND ASTHMA CLINIC OF CENTRAL TEXAS, PA
Entity type:Organization
Organization Name:ALLERGY AND ASTHMA CLINIC OF CENTRAL TEXAS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:512-388-1861
Mailing Address - Street 1:PO BOX 268945
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8945
Mailing Address - Country:US
Mailing Address - Phone:512-388-1861
Mailing Address - Fax:512-388-0373
Practice Address - Street 1:2000 N MAYS ST STE 109
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-2166
Practice Address - Country:US
Practice Address - Phone:254-690-2800
Practice Address - Fax:254-690-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4284207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1996407-01Medicaid
TX1960571-01Medicaid
TX1960577-01Medicaid
TX00791RMedicare PIN
TX00790RMedicare PIN