Healthcare Provider Details

I. General information

NPI: 1972629160
Provider Name (Legal Business Name): BRUCE C MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 MUNICIPAL DR
ARNOLD MO
63010-1012
US

IV. Provider business mailing address

227 E MAIN ST
FESTUS MO
63028-1952
US

V. Phone/Fax

Practice location:
  • Phone: 636-296-6206
  • Fax: 636-296-0102
Mailing address:
  • Phone: 636-931-2700
  • Fax: 636-931-5304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number2008014112
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2008014112
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: