Healthcare Provider Details

I. General information

NPI: 1295758365
Provider Name (Legal Business Name): JEFFREY T MACMILLAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W 4TH ST
KIMBALL NE
69145-1706
US

IV. Provider business mailing address

PO BOX 920
TORRINGTON WY
82240-0920
US

V. Phone/Fax

Practice location:
  • Phone: 308-235-1951
  • Fax:
Mailing address:
  • Phone: 913-894-2121
  • Fax: 913-894-9592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number04-25519
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number29753
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: