Healthcare Provider Details

I. General information

NPI: 1073520466
Provider Name (Legal Business Name): VIRGIL WAID MCMILLION D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HEALTHCARE DR
PHILIPPI WV
26416-9405
US

IV. Provider business mailing address

1 HEALTHCARE DR
PHILIPPI WV
26416-9405
US

V. Phone/Fax

Practice location:
  • Phone: 304-457-1760
  • Fax:
Mailing address:
  • Phone: 304-457-1760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2059
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2059
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: