1679534523 NPI number — JANE C MILLER MD

Table of content: JANE C MILLER MD (NPI 1679534523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679534523 NPI number — JANE C MILLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
JANE
Provider Middle Name:
C
Provider Name Prefix Text:
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:
CAGAN
Provider Other First Name:
JANE
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679534523
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4740 S I 10 SERVICE RD W
Provider Second Line Business Mailing Address:
STE 340
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70001-1234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-455-0004
Provider Business Mailing Address Fax Number:
504-455-0097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4740 SI- 10 SERVICE RD
Provider Second Line Business Practice Location Address:
STE 340
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-455-0004
Provider Business Practice Location Address Fax Number:
504-455-0097
Provider Enumeration Date:
03/30/2006

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: 207VG0400X , with the licence number:  015455 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0000X , with the licence number: 015455 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1329347 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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