1871811497 NPI number — MRS. ANTOINETTE LORRAINE MILLER BHRS

Table of content: MRS. ANTOINETTE LORRAINE MILLER BHRS (NPI 1871811497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871811497 NPI number — MRS. ANTOINETTE LORRAINE MILLER BHRS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
ANTOINETTE
Provider Middle Name:
LORRAINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BHRS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEZA
Provider Other First Name:
ANTOINETTE
Provider Other Middle Name:
LORRAINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
BHRS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871811497
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
227 E VAN BUREN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCALESTER
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74501-4132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-470-0896
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 S. 11TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTSHORNE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-297-3400
Provider Business Practice Location Address Fax Number:
918-297-3401
Provider Enumeration Date:
05/06/2010

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: 101YM0800X , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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