Miller Vascular, PA
Clinic/Center, Ambulatory Surgical in Fort Walton Beach, FL. Organization (NPI-2).
NPI number1427328343
StatusActive
Last updated in NPPESJan 9, 2012
Details
- NPI
- 1427328343
- Entity type
- Organization (NPI-2)
- Legal business name
- Miller Vascular, PA
- Organization subpart
- No
- Enumeration date
- Jan 9, 2012
- Last updated
- Jan 9, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QA1903X | Clinic/Center, Ambulatory Surgical | ME98427 | FL | Yes |
Other names
- Emaerald Coast Vein Center (Doing Business As)
Practice location
11 Racetrack Rd NeSuite E4
Fort Walton Beach, FL 32547-1882
Phone 850-200-4574 · Fax 850-200-4576
Mailing address
4607 Chanan DrCrestview, FL 32539-4341
Phone 850-682-2596
Authorized official
Michael Lee Miller
President
8503987088
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