NPI 1063661809

Mimi's

Organisation Exclusive Provider Organization Austin, TX

Practice location

Address: 12636 Research Blvd Suite C 109, Austin, TX 78759-2200
Phone: (512) 470-5943
Fax: (512) 231-1182

Authorised official

Name: Pat Canter Brenner
Title: Owner/Operator
Phone: (512) 470-5943

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X

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Registry record

NPI: 1063661809
Entity type: Organization
NPI issued: 17 Sep 2008
Record last updated: 17 Sep 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.