Basic Information
| Provider Information | |||||||||
| NPI: | 1326033705 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | RODNEY | ||||||||
| MiddleName: | ROSS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 825 2ND AVE | ||||||||
| Address2: | SUITE C6 | ||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421011786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703931912 | ||||||||
| FaxNumber: | 2703931913 | ||||||||
| Practice Location | |||||||||
| Address1: | 825 2ND AVE | ||||||||
| Address2: | SUITE C6 | ||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421011786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703931912 | ||||||||
| FaxNumber: | 2703931913 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2005 | ||||||||
| LastUpdateDate: | 03/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 34547 | KY | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 01061072A | IN | N | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0000X | 34547 | KY | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 208VP0014X | 34547 | KY | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 207LP2900X | 34547 | KY | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 64988751 | 05 | KY | MEDICAID | 200808200 | 05 | IN | MEDICAID | 389176 | 01 | IN | FGTBA BCBS ANTHEM # | OTHER |