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Organization
MILLER MAC GROUP, LLC
Active
Organization
MILLER MAC GROUP, LLC
Active
Other names
SOUTHLAKE PAIN AND SURGERY CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
KIM SIVARAMAN (BILLING MANAGER)
(214) 618-5600
Entity
Organization
Contact information
Practice address
300 S NOLEN DR STE 160, SOUTHLAKE, TX 76092-8054
(214) 618-5600
(214) 618-7733
Mailing address
5566 MAIN ST STE 210, FRISCO, TX 75033-3673
(214) 618-5600
(214) 618-7733
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
130212
TX
Other
Enumeration date
02/04/2015
Last updated
02/11/2015
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