1942384995 NPI number — STEPHEN B. MILLER

Table of content: (NPI 1942384995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942384995 NPI number — STEPHEN B. MILLER

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
COSMETIC & RECONSTRUCTIVE PLASTIC SURGERY, PLLC
Provider Other Organization Name Type Code:
4
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:
1942384995
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5187 US ROUTE 60 E
Provider Second Line Business Mailing Address:
SUITE # 9
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25705-2076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-399-2222
Provider Business Mailing Address Fax Number:
304-399-2223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5187 US ROUTE 60 E
Provider Second Line Business Practice Location Address:
SUITE # 9
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25705-2076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-399-2222
Provider Business Practice Location Address Fax Number:
304-399-2223
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
304-399-2222

Provider Taxonomy Codes

  • Taxonomy code: 208200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001722820 . This is a "BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1057260 . This is a "BRICKSTREET W/C" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 279747261-00 . This is a "OHIO WORKERS COMPENSTATIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 06-6033492 . This is a "AETNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1000263000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 240007609 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3810015078 . This is a "WV MEDICAID GROUP ID" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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