Healthcare Provider Details

I. General information

NPI: 1598022378
Provider Name (Legal Business Name): SCOTT MILLER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 09/01/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N HOSPITAL DR
PRICE UT
84501-4218
US

IV. Provider business mailing address

1094 E 200 S
SPRINGVILLE UT
84663-2712
US

V. Phone/Fax

Practice location:
  • Phone: 801-310-8458
  • Fax:
Mailing address:
  • Phone: 801-310-8458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number815882
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number5700298-4406
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: