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General NPI Number Information
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NPI Number | 1932251600
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Entity Type | Organization
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Legal Business Name | MARY C. MILLER MD PC
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2628 BROADWAY ST
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City | QUINCY
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State | IL
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Zip | 62301-3637
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Country | US
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Telephone | 217-224-1744
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Fax | 217-222-5827
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Provider Business Mailing Address
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Address Line | 2628 BROADWAY ST
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City | QUINCY
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State | IL
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Zip | 62301-3637
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Country | US
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Telephone | 217-224-1744
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Fax | 217-222-5827
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARY CARROLL MILLER
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Credential | MD
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Telephone | 217-224-1744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State | IL
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