1124028428 NPI number — DR. EDMUND E MILLER MD

Table of content: DR. EDMUND E MILLER MD (NPI 1124028428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124028428 NPI number — DR. EDMUND E MILLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
EDMUND
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1124028428
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
610 STATE FARM RD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
BOONE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28607-4738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-264-0042
Provider Business Mailing Address Fax Number:
828-264-8612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 STATE FARM RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BOONE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28607-4738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-264-0042
Provider Business Practice Location Address Fax Number:
828-264-8612
Provider Enumeration Date:
07/28/2005

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: 207W00000X , with the licence number:  22596 , 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: 8958907 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2074256 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4172879 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3058058 . This is a "BCBS TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 12160 . This is a "PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 53862 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 58907 . This is a "BCBS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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