1740283902 NPI number — DR. MARIE E MILLER D.C.

Table of content: DR. MARIE E MILLER D.C. (NPI 1740283902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740283902 NPI number — DR. MARIE E MILLER D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
MARIE
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WAREHAM
Provider Other First Name:
MARIE
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740283902
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1111 N 13TH ST STE 206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68102-4251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-345-7500
Provider Business Mailing Address Fax Number:
402-345-5228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15514 WAREHOUSE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENNINGTON
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68007-5510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
531-600-6542
Provider Business Practice Location Address Fax Number:
531-600-6544
Provider Enumeration Date:
05/23/2005

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: 111N00000X , with the licence number:  1339 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0972737 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 350019040 . This is a "RR MEDICARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 470729028-13 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09617 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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