1578589339 NPI number — DR. CECILE MAUGE MILLER MURRAY MD

Table of content: JENNIFER GARCIA (NPI 1104366780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578589339 NPI number — DR. CECILE MAUGE MILLER MURRAY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER MURRAY
Provider First Name:
CECILE
Provider Middle Name:
MAUGE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1578589339
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1624 MAIN STREET
Provider Second Line Business Mailing Address:
AGAPE SENIOR PRIMARY CARE, INC
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29201-2818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-726-2350
Provider Business Mailing Address Fax Number:
803-753-9102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1317 EBENEZER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCK HILL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-522-9175
Provider Business Practice Location Address Fax Number:
803-207-8207
Provider Enumeration Date:
07/14/2006

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: 207R00000X , with the licence number:  36251 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 231489 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 2008-00915 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02700470 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5910965 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00717905 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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