Provider Demographics
NPI:1205505344
Name:MILLS FAMILY PRACTICE
Entity type:Organization
Organization Name:MILLS FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:434-404-3970
Mailing Address - Street 1:PO BOX 1303
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-1303
Mailing Address - Country:US
Mailing Address - Phone:434-404-3970
Mailing Address - Fax:434-404-3371
Practice Address - Street 1:1320 SEYMOUR DR
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-3900
Practice Address - Country:US
Practice Address - Phone:434-579-0069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-11
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty