Provider Demographics
NPI:1790773414
Name:MILLER, JAMES C (CRNA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:MILLER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE #301
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6258
Mailing Address - Country:US
Mailing Address - Phone:610-402-9099
Mailing Address - Fax:610-402-9029
Practice Address - Street 1:1200 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6202
Practice Address - Country:US
Practice Address - Phone:610-402-9099
Practice Address - Fax:610-402-9029
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN511876L163W00000X
PA053595367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA79167OtherGEISINGER
PA1404537OtherKHP CENTRAL
PA1404537OtherFIRST PRIORITY
PA50003217OtherCAPITAL ADVANTAGE
PA0018729930003Medicaid
PA1544467OtherGATEWAY
PA1404537OtherHIGHMARK
PA9296481OtherAETNA
PA2092630000OtherINDEP. BLUE CROSS
PA11783689OtherCAQH
PA1404537OtherFIRST PRIORITY
PA50003217OtherCAPITAL ADVANTAGE
PA1404537OtherHIGHMARK