Provider Demographics
NPI:1619152337
Name:RICHARD S MILES PSC
Entity Type:Organization
Organization Name:RICHARD S MILES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER MD
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-866-2440
Mailing Address - Street 1:124 DOWELL RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642
Mailing Address - Country:US
Mailing Address - Phone:270-866-2440
Mailing Address - Fax:270-866-2442
Practice Address - Street 1:124 DOWELL RD
Practice Address - Street 2:
Practice Address - City:RUSSELL SPGS
Practice Address - State:KY
Practice Address - Zip Code:42642
Practice Address - Country:US
Practice Address - Phone:270-866-2440
Practice Address - Fax:270-866-2442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000047852OtherANTHEM BCBS
KY64197007Medicaid
C74179Medicare UPIN
1304001Medicare PIN