Basic Information
| Provider Information | |||||||||
| NPI: | 1700188497 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIRA HEALTHCARE OF TEXAS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 E LAMAR BLVD | ||||||||
| Address2: | SUITE 450 | ||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760067346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8178613994 | ||||||||
| FaxNumber: | 8178613926 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 SCENIC DR | ||||||||
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| City: | GEORGETOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786267726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8178613994 | ||||||||
| FaxNumber: | 8178613926 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2010 | ||||||||
| LastUpdateDate: | 12/01/2010 | ||||||||
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| AuthorizedOfficialLastName: | EICHENHOLZ | ||||||||
| AuthorizedOfficialFirstName: | PHILIP | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | CHAIRMAN/CEO | ||||||||
| AuthorizedOfficialTelephone: | 8778829099 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | TX | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.