1003042078 NPI number — LAUREN E MILLER P.A.

Table of content: LAUREN E MILLER P.A. (NPI 1003042078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003042078 NPI number — LAUREN E MILLER P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
LAUREN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
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:
1003042078
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1419 HAMRIC DR E
Provider Second Line Business Mailing Address:
#101
Provider Business Mailing Address City Name:
OXFORD
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36203-2173
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-235-3660
Provider Business Mailing Address Fax Number:
256-235-3663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 MEDICAL CENTER DR STE 402
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GADSDEN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35903-1104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-900-2000
Provider Business Practice Location Address Fax Number:
205-838-4525
Provider Enumeration Date:
06/04/2009

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: 363AM0700X , with the licence number:  PA642 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 187745 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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