Healthcare Provider Details

I. General information

NPI: 1386085405
Provider Name (Legal Business Name): ROLAND WESLEY MILLER BC-HIS, ACA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: WESLEY MILLER BC-HIS, ACA

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 E 5TH ST
ROSWELL NM
88201-6205
US

IV. Provider business mailing address

109 E 5TH ST
ROSWELL NM
88201-6205
US

V. Phone/Fax

Practice location:
  • Phone: 575-622-2887
  • Fax: 575-622-3379
Mailing address:
  • Phone: 575-622-2887
  • Fax: 575-622-3379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number470A
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: