1437169190 NPI number — DR. CELESTE MARIE MILLER-PARISH D.O

Table of content: DR. CELESTE MARIE MILLER-PARISH D.O (NPI 1437169190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437169190 NPI number — DR. CELESTE MARIE MILLER-PARISH D.O

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER-PARISH
Provider First Name:
CELESTE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MILLER
Provider Other First Name:
CELESTE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437169190
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 E SIGLER AVE
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63555-1726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-465-2828
Provider Business Mailing Address Fax Number:
660-465-2820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 E SIGLER AVE
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63555-1726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-465-2828
Provider Business Practice Location Address Fax Number:
660-465-2820
Provider Enumeration Date:
08/08/2006

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:  2002002085 , 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: 245788807 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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