MEDICARE: MARVIN RAY MILLER CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	43-557214-072	KS

General Provider Information

NPI Number	:	1598186348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARVIN RAY MILLER CRNA

Provider Business Mailing Address
First Line	:	13213 S SEGO RD
Second Line	:
City	:	ARLINGTON
State	:	KS
Zip	:	67514-9422
Country	:	US
Telephone Number	:	620-727-3926
Fax Number	:

Provider Business Practice Location Address
First Line	:	13410 W LAKE CABLE RD
Second Line	:
City	:	PARTRIDGE
State	:	KS
Zip	:	67566-9026
Country	:	US
Telephone Number	:	620-727-3926
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2013
Last Update Date	:	09/27/2021

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