Provider Demographics
NPI:1942384995
Name:STEPHEN B. MILLER
Entity Type:Organization
Organization Name:STEPHEN B. MILLER
Other - Org Name:COSMETIC & RECONSTRUCTIVE PLASTIC SURGERY, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-399-2222
Mailing Address - Street 1:5187 US ROUTE 60 E
Mailing Address - Street 2:SUITE # 9
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-2076
Mailing Address - Country:US
Mailing Address - Phone:304-399-2222
Mailing Address - Fax:304-399-2223
Practice Address - Street 1:5187 US ROUTE 60 E
Practice Address - Street 2:SUITE # 9
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2076
Practice Address - Country:US
Practice Address - Phone:304-399-2222
Practice Address - Fax:304-399-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001722820OtherBCBS
WV1057260OtherBRICKSTREET W/C
OH279747261-00OtherOHIO WORKERS COMPENSTATIO
WV06-6033492OtherAETNA
WV1000263000Medicaid
240007609OtherRAILROAD MEDICARE
WV3810015078OtherWV MEDICAID GROUP ID
WVH45162Medicare UPIN
WV001722820OtherBCBS