Provider Demographics
NPI:1033130125
Name:MILLER DIALYSIS SERVICES
Entity Type:Organization
Organization Name:MILLER DIALYSIS SERVICES
Other - Org Name:KIDNEY TREATMENT OPTIONS CENTER OF OPELOUSAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-594-0675
Mailing Address - Street 1:927 E PRUDHOMME ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-8240
Mailing Address - Country:US
Mailing Address - Phone:337-594-8535
Mailing Address - Fax:
Practice Address - Street 1:927 E PRUDHOMME ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-8240
Practice Address - Country:US
Practice Address - Phone:337-594-8535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA192665Medicare ID - Type UnspecifiedPROVIDER NUMBER