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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