1174596548 NPI number — MS. LINDA S MILHOLEN MD

Table of content: MS. LINDA S MILHOLEN MD (NPI 1174596548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174596548 NPI number — MS. LINDA S MILHOLEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILHOLEN
Provider First Name:
LINDA
Provider Middle Name:
S
Provider Name Prefix Text:
MS.
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:
1174596548
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 109
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65483-0109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-399-4707
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10981 HIGHWAY 63
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LICKING
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65542-9869
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-399-4707
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2006

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: 208600000X , with the licence number:  2001029380 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1174596548 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00171332 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 205687908 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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