Provider Demographics
NPI:1891053922
Name:STEPHEN A. MILLER,D.O.,P.A.
Entity Type:Organization
Organization Name:STEPHEN A. MILLER,D.O.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:620-251-0777
Mailing Address - Street 1:1717 WEST 8TH
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-3101
Mailing Address - Country:US
Mailing Address - Phone:620-251-0777
Mailing Address - Fax:620-251-4173
Practice Address - Street 1:1717 W 8TH ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-3101
Practice Address - Country:US
Practice Address - Phone:620-251-0777
Practice Address - Fax:620-251-4173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0521872302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100206010BMedicaid
KSD17407Medicare UPIN
KS100206010BMedicaid