Provider Demographics
NPI:1356560528
Name:MILLER FAMILY MEDICINE, LLC
Entity type:Organization
Organization Name:MILLER FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, SMH PHYSICIANS NETWORK
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:QUICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-649-8873
Mailing Address - Street 1:140 E I 10 SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-3564
Mailing Address - Country:US
Mailing Address - Phone:985-847-9909
Mailing Address - Fax:985-847-9902
Practice Address - Street 1:1001 GAUSE BLVD
Practice Address - Street 2:BOX 75
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2939
Practice Address - Country:US
Practice Address - Phone:985-639-8970
Practice Address - Fax:985-639-8971
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SLIDELL MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-25
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12706R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1801020433OtherNPI PHYSICIANS NETWORK IDENTIFICATION NUMBER
LA5CD84Medicare ID - Type Unspecified
LAF91399Medicare UPIN