Organization
MILLER ANESTHESIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY A MILLER CRNA (PRESIDENT)
(573) 686-5550
Entity
Organization
Contact information
Practice address
100 MEDICAL CENTER DR, PADUCAH, KY 42003-7909
(270) 442-1024
Mailing address
140 ROSEMONT DR, PADUCAH, KY 42001-9276
(573) 686-5550
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000318171
KY BCBS GROUP
KY
05
—
74900838
—
KY
01
—
DA4729
RR MEDICARE GROUP
KY
Enumeration date
10/06/2005
Last updated
07/21/2022
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