Healthcare Provider Details

I. General information

NPI: 1780609107
Provider Name (Legal Business Name): STEPHEN MICHAEL MILLER DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 09/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3921 SENECA TRAIL SOUTH
PETERSTOWN WV
24963
US

IV. Provider business mailing address

PO BOX 430
PETERSTOWN WV
24963-0430
US

V. Phone/Fax

Practice location:
  • Phone: 304-753-9100
  • Fax: 304-753-9353
Mailing address:
  • Phone: 304-753-9100
  • Fax: 304-753-9353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN MICHAEL MILLER
Title or Position: OWNER
Credential: D.O
Phone: 304-753-9100