1194020503 NPI number — MRS. SARA MONTAGUE MILLER M.S.

Table of content: TAMI L GLADUE RN (NPI 1679755078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194020503 NPI number — MRS. SARA MONTAGUE MILLER M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
SARA
Provider Middle Name:
MONTAGUE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MONTAGUE
Provider Other First Name:
SARA
Provider Other Middle Name:
AMES
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194020503
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2112 BIENVILLE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCEAN SPRINGS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39564-3052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-875-1590
Provider Business Mailing Address Fax Number:
228-875-1591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2112 BIENVILLE BLVD STE M2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCEAN SPRINGS
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39564-3027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-215-0825
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/14/2011

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: 101YP2500X , with the licence number:  1728 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00018214 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".