| Mills Clinic A Professional Medical Corporation | |
|
7225 Fern Avenue Suite 600 Shreveport LA 71105-4981 | |
| (318) 629-3630 | |
| (318) 629-3640 |
| Full Name | Mills Clinic A Professional Medical Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 7225 Fern Avenue, Shreveport, Louisiana |
| Authorized Official Name and Position | Bryan Haywood Mills (MD OWNER PRESIDENT) |
| Authorized Official Contact | 3186293630 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mills Clinic A Professional Medical Corporation 7225 Fern Avenue Suite 600 Shreveport LA 71105-4981 Ph: (318) 629-3630 | Mills Clinic A Professional Medical Corporation 7225 Fern Avenue Suite 600 Shreveport LA 71105-4981 Ph: (318) 629-3630 |
| NPI Number | 1649328030 |
|---|---|
| Provider Enumeration Date | 01/08/2007 |
| Last Update Date | 10/14/2008 |
| Medicare PECOS PAC ID | 1355365875 |
|---|---|
| Medicare Enrollment ID | O20060123000701 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649328030 | NPI | - | NPPES |
| 1989088 | Medicaid | LA | |
| 19D1047971 | Other | CLIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Bryan Mills |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1407845266 PECOS PAC ID: 4284687971 Enrollment ID: I20050222000793 |
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