Healthcare Provider Details

I. General information

NPI: 1710942149
Provider Name (Legal Business Name): THOMAS MINER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 06/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 5TH ST
MILLER SD
57362-1238
US

IV. Provider business mailing address

PO BOX 287
MILLER SD
57362-0287
US

V. Phone/Fax

Practice location:
  • Phone: 605-853-2447
  • Fax: 605-853-3885
Mailing address:
  • Phone: 605-853-2447
  • Fax: 605-853-3885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0365
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: