MEDICARE: WEST POINT INTERNAL MEDICINE CLINIC, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	28771	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235361304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST POINT INTERNAL MEDICINE CLINIC, PA

Provider Business Mailing Address
First Line	:	830 MEDICAL CENTER DR
Second Line	:
City	:	WEST POINT
State	:	MS
Zip	:	39773-9319
Country	:	US
Telephone Number	:	662-377-4685
Fax Number	:

Provider Business Practice Location Address
First Line	:	830 MEDICAL CENTER DR
Second Line	:
City	:	WEST POINT
State	:	MS
Zip	:	39773-9319
Country	:	US
Telephone Number	:	662-377-4685
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EDMUND ANDERSON MILLER JR.
Credential	:	M.D.
Telephone Number	:	662-377-4685

Provider Enumeration Date	:	08/21/2009
Last Update Date	:	04/18/2011

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