Provider Demographics
NPI:1982097804
Name:MILLER ORTHOPAEDIC AFFILIATES PC
Entity Type:Organization
Organization Name:MILLER ORTHOPAEDIC AFFILIATES PC
Other - Org Name:MILLER ORTHOPEDIC SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:712-323-5333
Mailing Address - Street 1:1 EDMUNDSON PL
Mailing Address - Street 2:STE 500
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4619
Mailing Address - Country:US
Mailing Address - Phone:712-323-5333
Mailing Address - Fax:712-323-3252
Practice Address - Street 1:16221 EVANS PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-6444
Practice Address - Country:US
Practice Address - Phone:402-991-9958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILLER ORTHOPAEDIC AFFILIATES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-17
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies