Provider Demographics
NPI:1033326905
Name:ARCHIBALD S MILLER MD PC
Entity Type:Organization
Organization Name:ARCHIBALD S MILLER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARCHIBALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:918-492-2282
Mailing Address - Street 1:6585 S YALE AVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8316
Mailing Address - Country:US
Mailing Address - Phone:918-492-2282
Mailing Address - Fax:918-491-9188
Practice Address - Street 1:6585 S YALE AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8316
Practice Address - Country:US
Practice Address - Phone:918-492-2282
Practice Address - Fax:918-491-9188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15356174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100013190AMedicaid
OK105407943Medicare PIN
OK100013190AMedicaid