Provider Demographics
NPI:1346418928
Name:DOLORES M. MILLER
Entity Type:Organization
Organization Name:DOLORES M. MILLER
Other - Org Name:PERSONAL CHOICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MASTECTOMY FITTER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-459-0170
Mailing Address - Street 1:3512 QUAIL RUN DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-3550
Mailing Address - Country:US
Mailing Address - Phone:520-459-0170
Mailing Address - Fax:520-459-1241
Practice Address - Street 1:3512 QUAIL RUN DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-3550
Practice Address - Country:US
Practice Address - Phone:520-459-0170
Practice Address - Fax:520-459-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ02029087332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3962940001Medicare NSC