Organization
LINDA MILLER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CECE J PANNELL (OFFICE MANAGER)
(817) 294-7444
Entity
Organization
Contact information
Practice address
1400 8TH AVE, FORT WORTH, TX 76104-4110
(817) 926-2544
Mailing address
PO BOX 2626, FORT WORTH, TX 76113-2626
(817) 294-7444
(817) 294-7172
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
25876
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0098KJ
BCBS
TX
Enumeration date
09/22/2008
Last updated
09/22/2008
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