Miller Mac Group, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

130212 Issued in TX

Legal business name

MILLER MAC GROUP, LLC

Doing business as

SOUTHLAKE PAIN AND SURGERY CENTER

Practice address

300 S Nolen Dr Ste 160
Southlake, TX 76092-8054

Phone

(214) 618-5600

Fax

(214) 618-7733

NPI assigned

Feb 4, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kim Sivaraman

Title

Billing Manager

Phone

(214) 618-5600

Specialties & licenses 1

Addresses

Other names 1

• SOUTHLAKE PAIN AND SURGERY CENTER Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1423008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423612800000",
    "number": "1649660168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5566 MAIN ST STE 210",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750333673",
            "telephone_number": "214-618-5600",
            "fax_number": "214-618-7733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S NOLEN DR STE 160",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760928054",
            "telephone_number": "214-618-5600",
            "fax_number": "214-618-7733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLER MAC GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-04",
        "last_updated": "2015-02-11",
        "status": "A",
        "authorized_official_last_name": "SIVARAMAN",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "214-618-5600"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TX",
            "license": "130212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTHLAKE PAIN AND SURGERY CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Keyera Milburn
• Catherine Celeste Miles, CPHT
• Jennifer Miles, DNP, APRN
• Kayla Anne Miles
• Kathryn Margaret Millar, PA-C
• Allison Miller, DPT
• Ashlea Miller
• Jennifer Miller, PA
• Laurie K Miller, MOT,OTR
• Rebecca Miller, PTA

• Ambulatory Surgical Clinic/Center in Southlake, TX
• Providers in Southlake, TX by specialty
• Ambulatory Surgical Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.