1194020503 NPI number — MRS. SARA MONTAGUE MILLER M.S.

Table of content: MRS. SARA MONTAGUE MILLER M.S. (NPI 1194020503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194020503 NPI number — MRS. SARA MONTAGUE MILLER M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
SARA
Provider Middle Name:
MONTAGUE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MONTAGUE
Provider Other First Name:
SARA
Provider Other Middle Name:
AMES
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194020503
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2112 BIENVILLE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCEAN SPRINGS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39564-3052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-875-1590
Provider Business Mailing Address Fax Number:
228-875-1591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2112 BIENVILLE BLVD STE M2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCEAN SPRINGS
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39564-3027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-215-0825
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/14/2011

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: 101YP2500X , with the licence number:  1728 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00018214 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".