1548247224 NPI number — MR. LEE GARRETT MILLER PT

Table of content: (NPI 1902875339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548247224 NPI number — MR. LEE GARRETT MILLER PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
LEE
Provider Middle Name:
GARRETT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MILLER
Provider Other First Name:
LEE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1548247224
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
441 MOOSA BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUNICE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70535-3627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-457-8164
Provider Business Mailing Address Fax Number:
337-546-6515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
441 MOOSA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUNICE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70535-3627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-457-8164
Provider Business Practice Location Address Fax Number:
337-546-6515
Provider Enumeration Date:
12/23/2005

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: 225100000X , with the licence number:  06871 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1019437 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1409146 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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