Provider Demographics
NPI:1801854666
Name:MILLER, RICHARD E (CRNA)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
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:PO BOX 821
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25323-0821
Mailing Address - Country:US
Mailing Address - Phone:843-669-5162
Mailing Address - Fax:843-667-4573
Practice Address - Street 1:3911 B HWY 17
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576
Practice Address - Country:US
Practice Address - Phone:843-669-5162
Practice Address - Fax:843-667-4573
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPRN478367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC204185222OtherTRICARE
SCGP4376OtherRR MEDICARE
SCAN0577Medicaid
SCP00303175OtherRR MEDICARE
SCGP4376Medicaid
SC196586OtherMEDCOST
SC204185222OtherBCBS OF SC
SC$$$$$$$$$OtherBCBS OF SC
SCGP4376Medicaid
SCQ311708472Medicare PIN