Provider Demographics
NPI:1295758365
Name:MACMILLAN, JEFFREY T (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:T
Last Name:MACMILLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 920
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-0920
Mailing Address - Country:US
Mailing Address - Phone:913-894-2121
Mailing Address - Fax:913-894-9592
Practice Address - Street 1:255 W 4TH ST
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:NE
Practice Address - Zip Code:69145-1706
Practice Address - Country:US
Practice Address - Phone:308-235-1951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-25519207X00000X
NE29753207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200030413OtherRR MEDICARE
KS100171940AMedicaid
KS431793993OtherTRIWEST
KS0982140OtherUNITED HEALTHCARE
KS141094900OtherUS DEPARTMENT OF LABOR
KS15076140OtherHUMANA
MO208162701Medicaid
KS21793010OtherBCBS KC
KS200030413OtherRR MEDICARE
KS141094900OtherUS DEPARTMENT OF LABOR
MO208162701Medicaid
KS100171940AMedicaid
MOY44000Medicare PIN