Provider Demographics
NPI:1508136219
Name:MARTIN MILLER GROUP
Entity Type:Organization
Organization Name:MARTIN MILLER GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP, LADC
Authorized Official - Phone:402-463-5075
Mailing Address - Street 1:225 N SAINT JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-7555
Mailing Address - Country:US
Mailing Address - Phone:402-463-5075
Mailing Address - Fax:402-463-5073
Practice Address - Street 1:225 N SAINT JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-7555
Practice Address - Country:US
Practice Address - Phone:402-463-5075
Practice Address - Fax:402-463-5073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE701101YA0400X
NE1073101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026137700Medicaid