1124299672 NPI number — S RICK MILLER D P M PROFESSIONAL CORPORATION

Table of content: (NPI 1124299672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124299672 NPI number — S RICK MILLER D P M PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S RICK MILLER D P M PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1124299672
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 GODWARD ST NE
Provider Second Line Business Mailing Address:
STE 4100
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55413-1741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-242-0660
Provider Business Mailing Address Fax Number:
972-242-7596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2150 N JOSEY LN
Provider Second Line Business Practice Location Address:
#202
Provider Business Practice Location Address City Name:
CARROLLTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75006-2991
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-242-0660
Provider Business Practice Location Address Fax Number:
972-242-7596
Provider Enumeration Date:
03/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
RICK
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
972-242-0660

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  0562 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1124299672 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0927527-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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