Milton Evans Willis, PA
Individual provider Active NPI Medical Physician Assistant · Winnie, TX
NPI 1881635019 · NPPES record last updated Feb 23, 2009
Key facts
- NPI
- 1881635019
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- PA00964 (TX)
- Practice address
- 538 Broadway
Winnie, TX 77665-7600 - Phone
- (409) 296-9505
- Fax
- (409) 296-2506
- NPI assigned
- Jun 9, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA00964 | TX | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Christopher Medical Clinic, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA00964 | TX | Yes |
Addresses
Primary practice location
538 Broadway
Winnie, TX 77665-7600
Mailing address
PO Box 714
Winnie, TX 77665-0714
Phone (409) 296-9505
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8Y1053 | Other | TX | BCBS |
Other providers in Winnie, TX
- The Arboretum Nursing and Rehabilitation Center of Winnie, Inc.
- Thompson Outpatient Clinic, LLC
- Danny Lee Thompson
- Sarah J Thompson
- Wilcrx ENT.,Inc.
- Winnie Community Hospital, L.L.C.
- Winnie Community Hospital, LLC
- Winnie Community Hospital, LLC
- Winnie Community Hospital, LLC
- Winnie Family Dental PLLC
All providers in Winnie, TX · Medical Physician Assistant in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 23, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.