1578514477 NPI number — DR. STEPHEN L MILLER MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578514477 NPI number — DR. STEPHEN L MILLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
STEPHEN
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578514477
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5292 COLLEGE DR
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
MURRAY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84123-2672
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-281-4278
Provider Business Mailing Address Fax Number:
801-281-5960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5292 COLLEGE DR
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84123-2672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-281-4278
Provider Business Practice Location Address Fax Number:
801-281-5960
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  360531-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 25-00453 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 202083175 . This is a "UHC MEDICARE COMPLETE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 235735 . This is a "ALTIUS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 107007155103 . This is a "SELECT HEALTH" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 202083175 . This is a "AETNA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 202083175SLM . This is a "EDUCATORS MUTUAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 350135 . This is a "DESERET MUTUAL BENEFITS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: P00254258 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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