Provider Demographics
NPI:1942496989
Name:MINIAT WORKS LLC
Entity Type:Organization
Organization Name:MINIAT WORKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MINIAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-653-1212
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:PORT ST JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32457-0007
Mailing Address - Country:US
Mailing Address - Phone:850-653-1212
Mailing Address - Fax:850-227-9737
Practice Address - Street 1:137 12TH ST
Practice Address - Street 2:
Practice Address - City:APALACHICOLA
Practice Address - State:FL
Practice Address - Zip Code:32320-2110
Practice Address - Country:US
Practice Address - Phone:850-653-1212
Practice Address - Fax:850-227-9737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0072123173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8400Medicare PIN