MEDICARE: JUSTIN A OVERMILLER MD

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	207Q00000X	Family Medicine Physician	6299	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	104644	OTHER	KS	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1578539219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN A OVERMILLER MD

Provider Business Mailing Address
First Line	:	921 E HIGHWAY 36
Second Line	:
City	:	SMITH CENTER
State	:	KS
Zip	:	66967-9582
Country	:	US
Telephone Number	:	785-282-6834
Fax Number	:	785-282-3793

Provider Business Practice Location Address
First Line	:	921 E HIGHWAY 36
Second Line	:
City	:	SMITH CENTER
State	:	KS
Zip	:	66967
Country	:	US
Telephone Number	:	785-282-6834
Fax Number	:	785-282-3793

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	08/29/2018

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Directions to “ JUSTIN A OVERMILLER MD” Practice Location

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