1184646630 NPI number — JAMIE T. MILLER APRN

Table of content: JAMIE T. MILLER APRN (NPI 1184646630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184646630 NPI number — JAMIE T. MILLER APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
JAMIE
Provider Middle Name:
T.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LYNCH
Provider Other First Name:
JAMIE
Provider Other Middle Name:
T.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184646630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 CLINIC DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISONVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42431-1661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISONVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42431-1658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-326-3800
Provider Business Practice Location Address Fax Number:
270-326-3805
Provider Enumeration Date:
07/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  3004327 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000343427 . This is a "BCBS PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 78012788 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01198573 . This is a "RAILROAD MEDICARE WALMART LOCATION" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 718788 . This is a "ANTHEM- WALMART CLINIC MVILLE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com