Healthcare Provider Details

I. General information

NPI: 1427441633
Provider Name (Legal Business Name): MR. ELROY MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 BOULDER CREEK PKWY
LAFAYETTE LA
70508-1718
US

IV. Provider business mailing address

407 BOULDER CREEK PKWY
LAFAYETTE LA
70508-1718
US

V. Phone/Fax

Practice location:
  • Phone: 337-580-3107
  • Fax: 337-857-2712
Mailing address:
  • Phone: 337-580-3107
  • Fax: 337-857-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number47-3230810
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: