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General NPI Number Information
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NPI Number | 1366511180
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Entity Type | Organization
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Legal Business Name | MILLER CLINIC LTD
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 500 SAVAGE ST
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City | WICKENBURG
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State | AZ
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Zip | 85390
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Country | US
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Telephone | 928-684-2425
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Fax | 928-684-0387
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Provider Business Mailing Address
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Address Line | PO BOX 100
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City | WICKENBURG
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State | AZ
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Zip | 85358-0100
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Country | US
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Telephone | 928-684-2425
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Fax | 928-684-0387
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Authorized Official
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Title or Position | PRESIDENT
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Name | VANCE B MILLER
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Credential | MD
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Telephone | 928-684-2425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9739
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License Number State | AZ
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