1689981391 NPI number — MILLER HEALTHCARE NETWORK LLC

Table of Contents

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: 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: 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: 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: 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" .
  • 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" .

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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