# MILLER ORTHOPAEDIC AFFILIATES PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659379519
- **Authorized official:** DR. DANIEL J. LAROSE MD (PRESIDENT)
- **Authorized official phone:** (712) 323-5333

## Contact information

- **Practice address:** 1 EDMUNDSON PLACE, SUITE 500, COUNCIL BLUFFS, IA 51503-4619
- **Practice address phone:** (712) 323-5333
- **Practice address fax:** (712) 323-3252
- **Mailing address:** 1 EDMUNDSON PL, STE 500, COUNCIL BLUFFS, IA 51503-4619
- **Mailing address phone:** (712) 323-5333
- **Mailing address fax:** (712) 323-3252

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | — |
| 2251X0800X | Orthopedic Physical Therapist | — | NULL | — |
| 2251X0800X | Orthopedic Physical Therapist | — | — | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 332BC3200X | Customized Equipment (DME) | — | NULL | — |
| 335E00000X | Prosthetic/Orthotic Supplier | — | NULL | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 07/13/2005
- **Last updated:** 07/16/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0119040 | — | IA |
| 05 | — | 0701830 | — | IA |
| 05 | — | 0701871 | — | IA |
| 05 | — | 0701872 | — | IA |
| 05 | — | 0701873 | — | IA |
| 01 | — | 09602 | WELLMARK GRP \# | IA |
| 05 | — | 10025346400 | — | NE |