MEDICARE: STEPHEN MICHAEL MILLER DO

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	261QR1300X	Rural Health Clinic/Center
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1780609107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN MICHAEL MILLER DO

Provider Business Mailing Address
First Line	:	PO BOX 430
Second Line	:
City	:	PETERSTOWN
State	:	WV
Zip	:	24963-0430
Country	:	US
Telephone Number	:	304-753-9100
Fax Number	:	304-753-9353

Provider Business Practice Location Address
First Line	:	3921 SENECA TRAIL SOUTH
Second Line	:
City	:	PETERSTOWN
State	:	WV
Zip	:	24963
Country	:	US
Telephone Number	:	304-753-9100
Fax Number	:	304-753-9353

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHEN MICHAEL MILLER
Credential	:	D.O
Telephone Number	:	304-753-9100

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	09/08/2009

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