1518142793 NPI number — MILLER MEDI-VAN, INC.

Table of content: MARY JAYNE BRENNAN ARNP (NPI 1164424628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518142793 NPI number — MILLER MEDI-VAN, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILLER MEDI-VAN, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CONTEMPORARY TRANSPORTATION
Provider Other Organization Name Type Code:
3
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:
1518142793
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
904 19TH AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55404-2202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-332-2888
Provider Business Mailing Address Fax Number:
612-332-2999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
904 19TH AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55404-2202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-332-2888
Provider Business Practice Location Address Fax Number:
612-332-2999
Provider Enumeration Date:
01/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
612-332-2888

Provider Taxonomy Codes

  • Taxonomy code: 343800000X , with the licence number:  108792 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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