Provider Demographics
NPI:1780788828
Name:DIX RIVER FAMILY MEDICINE & WOMENS HEALTHCARE CENTER PSC
Entity type:Organization
Organization Name:DIX RIVER FAMILY MEDICINE & WOMENS HEALTHCARE CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALVIN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-365-1547
Mailing Address - Street 1:PO BOX 330
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:KY
Mailing Address - Zip Code:40484-0330
Mailing Address - Country:US
Mailing Address - Phone:606-365-1547
Mailing Address - Fax:606-365-8380
Practice Address - Street 1:102 AGRICULTURAL WAY
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:KY
Practice Address - Zip Code:40484-1461
Practice Address - Country:US
Practice Address - Phone:606-365-1547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY=========Medicaid
KY=========Medicaid
KY5551Medicare PIN