Provider Demographics
NPI:1396065181
Name:LINDA E. MILLER, LLC
Entity type:Organization
Organization Name:LINDA E. MILLER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, CS
Authorized Official - Phone:314-307-1011
Mailing Address - Street 1:11425 UPHILL TRL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138-3401
Mailing Address - Country:US
Mailing Address - Phone:636-230-0411
Mailing Address - Fax:636-230-0421
Practice Address - Street 1:11425 UPHILL TRL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138-3401
Practice Address - Country:US
Practice Address - Phone:636-230-0411
Practice Address - Fax:636-230-0421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN554563364SP0813X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0813XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, GeropsychiatricGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
157244OtherANTHEM BLUE CROSS/BLUE SHIELD
MO4246753338Medicaid
000083084Medicare PIN
157244OtherANTHEM BLUE CROSS/BLUE SHIELD