MEDICARE: MILLER SURGICAL ASSISTING, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	246ZC0007X	Surgical Assistant
2	246ZX2200X	Orthopedic Assistant
3	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1871990663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLER SURGICAL ASSISTING, LLC

Provider Business Mailing Address
First Line	:	PO BOX 122131
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-0036
Country	:	US
Telephone Number	:	305-814-6542
Fax Number	:

Provider Business Practice Location Address
First Line	:	2307 W BROWARD BLVD STE 200
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-1417
Country	:	US
Telephone Number	:	305-814-6542
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	THOMAS DANIEL MILLER
Credential	:	OA-C, CSFA
Telephone Number	:	305-814-6542

Provider Enumeration Date	:	11/24/2014
Last Update Date	:	04/27/2017

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