1992715122 NPI number — KENNETH L MILLER MD

Table of content: KENNETH L MILLER MD (NPI 1992715122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992715122 NPI number — KENNETH L MILLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
KENNETH
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992715122
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 629
Provider Second Line Business Mailing Address:
SMITH IMAGING INC
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-760-8075
Provider Business Mailing Address Fax Number:
314-821-2180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 W LIBERTY
Provider Second Line Business Practice Location Address:
PARKLAND HEALTH CENTER DEPT OF RADIOLOGY
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-760-8075
Provider Business Practice Location Address Fax Number:
573-760-8358
Provider Enumeration Date:
08/09/2006

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: 2085R0202X , with the licence number:  109972 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 109972 . This is a "LICENSE NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8707 . This is a "HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 945K1 . This is a "MO BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14989V14989 . This is a "GHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 290568 . This is a "CMR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 290568 . This is a "HL" identifier . This identifiers is of the category "OTHER".
  • Identifier: G23727 . This is a "NATIONAL REGISTRY NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 290568 . This is a "AMER MEDSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 945K1 . This is a "BCBS MO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 945K1 . This is a "IL BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: STL1600408 . This is a "UHC" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com