Provider Demographics
NPI:1598756652
Name:MILLER COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:MILLER COUNTY BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-352-4275
Mailing Address - Street 1:250 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:COLQUITT
Mailing Address - State:GA
Mailing Address - Zip Code:39837-3532
Mailing Address - Country:US
Mailing Address - Phone:229-758-3344
Mailing Address - Fax:229-758-5526
Practice Address - Street 1:250 W PINE ST
Practice Address - Street 2:
Practice Address - City:COLQUITT
Practice Address - State:GA
Practice Address - Zip Code:39837-3532
Practice Address - Country:US
Practice Address - Phone:229-758-3344
Practice Address - Fax:229-758-5526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00452933IMedicaid
GA00456475IMedicaid
GA507035641AMedicaid
GA00052049JMedicaid
GA00442879CMedicaid
GAFLU224Medicare ID - Type UnspecifiedFLU BILLING