1780925834 NPI number — MILLER PROSTHETICS & ORTHOTICS

Table of content: (NPI 1780925834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780925834 NPI number — MILLER PROSTHETICS & ORTHOTICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILLER PROSTHETICS & ORTHOTICS
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:
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:
1780925834
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2354 RICHMILLER LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELPRE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45714-1052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-421-4211
Provider Business Mailing Address Fax Number:
888-972-5171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2311 OHIO AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26101-2559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-699-2373
Provider Business Practice Location Address Fax Number:
888-972-5171
Provider Enumeration Date:
03/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
MARK
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
PROSTHETIST, ORHTOTIST, OWNER
Authorized Official Telephone Number:
304-699-2373

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  LPO 074 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3810025834 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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