1689981391 NPI number — MILLER HEALTHCARE NETWORK LLC

Table of content: (NPI 1689981391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689981391 NPI number — MILLER HEALTHCARE NETWORK LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILLER HEALTHCARE NETWORK 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:
6
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:
1689981391
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6073 NW 167TH ST
Provider Second Line Business Mailing Address:
SUITE C-7
Provider Business Mailing Address City Name:
HIALEAH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33015-4336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-663-9790
Provider Business Mailing Address Fax Number:
305-395-5239

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6073 NW 167TH ST
Provider Second Line Business Practice Location Address:
SUITE C7
Provider Business Practice Location Address City Name:
HIALEAH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33015-4336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-663-9790
Provider Business Practice Location Address Fax Number:
305-395-5239
Provider Enumeration Date:
09/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
MARTINE
Authorized Official Middle Name:
JULES
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
786-663-9790

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  30211621 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WH0200X , with the licence number: 30211621 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WI0500X , with the licence number: 30211621 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 164W00000X , with the licence number: 30211621 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 30211621 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251F00000X , with the licence number: 30211621 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X , with the licence number: 30211621 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: 231125 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 372500000X , with the licence number: 30211621 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 372600000X , with the licence number: 30211621 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747A0650X , with the licence number: 30211621 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747P1801X , with the licence number: 30211621 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 374U00000X , with the licence number: 30211621 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376J00000X , with the licence number: 30211621 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376K00000X , with the licence number: 30211621 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 001866900 . This is a "ADA/PAC MEDICAID WAIVER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 002664300 . This is a "MEDICAID STATE PLAN / PCA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 003059300 . This is a "APD MEDICAID WAIVER (DEVELOPMENTAL DISABILITIES)" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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