Provider Demographics
NPI:1295770600
Name:LITTLE KANAWHA FAMILY MEDICINE PLLC
Entity type:Organization
Organization Name:LITTLE KANAWHA FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HILLARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO MPH
Authorized Official - Phone:304-462-7460
Mailing Address - Street 1:604 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26351
Mailing Address - Country:US
Mailing Address - Phone:304-462-7460
Mailing Address - Fax:304-462-7461
Practice Address - Street 1:604 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:WV
Practice Address - Zip Code:26351
Practice Address - Country:US
Practice Address - Phone:304-462-7460
Practice Address - Fax:304-462-7461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1999207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002135Medicaid
I19680Medicare UPIN
WV3810002135Medicaid