1316124704 NPI number — OSAGE ARKMO SURGICAL SERVICES, LLC

Table of content: DR. JANICE SUSAN MILLER MD (NPI 1134281793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316124704 NPI number — OSAGE ARKMO SURGICAL SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OSAGE ARKMO SURGICAL SERVICES, LLC
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:
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:
1316124704
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6339 E SPEEDWAY BLVD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85710-1147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-323-8732
Provider Business Mailing Address Fax Number:
520-547-1865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
334 E KEARNEY ST
Provider Second Line Business Practice Location Address:
PMB: 221
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65803-3018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-323-8732
Provider Business Practice Location Address Fax Number:
520-258-0304
Provider Enumeration Date:
01/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DINH
Authorized Official First Name:
LACEY
Authorized Official Middle Name:
Authorized Official Title or Position:
REVENUE CYCLE MANAGER OF ABS
Authorized Official Telephone Number:
520-258-0326

Provider Taxonomy Codes

  • Taxonomy code: 261QL0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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