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General NPI Number Information
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NPI Number | 1780609107
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Entity Type | Organization
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Legal Business Name | STEPHEN MICHAEL MILLER DO
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 09/08/2009
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Provider Practice Location Address
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Address Line | 3921 SENECA TRAIL SOUTH
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City | PETERSTOWN
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State | WV
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Zip | 24963
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Country | US
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Telephone | 304-753-9100
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Fax | 304-753-9353
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Provider Business Mailing Address
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Address Line | PO BOX 430
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City | PETERSTOWN
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State | WV
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Zip | 24963-0430
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Country | US
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Telephone | 304-753-9100
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Fax | 304-753-9353
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Authorized Official
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Title or Position | OWNER
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Name | STEPHEN MICHAEL MILLER
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Credential | D.O
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Telephone | 304-753-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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