Basic Information
| Provider Information | |||||||||
| NPI: | 1124355219 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GEORGE E. MILLER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3747 W FORK RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452477548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139614335 | ||||||||
| FaxNumber: | 5139614227 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 MEDICAL VILLAGE DR | ||||||||
| Address2: | SUITE 338 | ||||||||
| City: | EDGEWOOD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410175401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593415035 | ||||||||
| FaxNumber: | 8593419080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2009 | ||||||||
| LastUpdateDate: | 02/11/2010 | ||||||||
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| AuthorizedOfficialLastName: | KNOEBEL | ||||||||
| AuthorizedOfficialFirstName: | CONNIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5139614335 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CRANLEY SURGICAL ASSOCIATES | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 17684 | KY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 64-176845 | 05 | KY | MEDICAID | C69638 | 01 | KY | UPIN | OTHER |