Provider Demographics
NPI:1497797195
Name:WAYNE R MILLER MD
Entity Type:Organization
Organization Name:WAYNE R MILLER MD
Other - Org Name:MILLER FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-644-5050
Mailing Address - Street 1:255 W SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:SHAMOKIN
Mailing Address - State:PA
Mailing Address - Zip Code:17872-5811
Mailing Address - Country:US
Mailing Address - Phone:570-644-5050
Mailing Address - Fax:570-644-2578
Practice Address - Street 1:255 W SPRUCE ST
Practice Address - Street 2:
Practice Address - City:SHAMOKIN
Practice Address - State:PA
Practice Address - Zip Code:17872-5811
Practice Address - Country:US
Practice Address - Phone:570-644-5050
Practice Address - Fax:570-644-2578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042431L261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012068790005Medicaid
PA0012068790005Medicaid