Provider Demographics
NPI:1801019880
Name:MILLS, STEVEN R (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:MILLS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 E MCMURTRY AVE
Mailing Address - Street 2:PO BOX 148
Mailing Address - City:HARTFORD
Mailing Address - State:KY
Mailing Address - Zip Code:42347-1647
Mailing Address - Country:US
Mailing Address - Phone:270-504-1300
Mailing Address - Fax:270-504-1380
Practice Address - Street 1:20 E MCMURTRY AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:KY
Practice Address - Zip Code:42347-1647
Practice Address - Country:US
Practice Address - Phone:270-504-1300
Practice Address - Fax:270-504-1380
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03089207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100054100Medicaid
KY7100054100Medicaid