Provider Demographics
NPI:1780925834
Name:MILLER PROSTHETICS & ORTHOTICS
Entity type:Organization
Organization Name:MILLER PROSTHETICS & ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHETIST, ORHTOTIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, LPO
Authorized Official - Phone:304-699-2373
Mailing Address - Street 1:2354 RICHMILLER LN
Mailing Address - Street 2:
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714-1052
Mailing Address - Country:US
Mailing Address - Phone:740-421-4211
Mailing Address - Fax:888-972-5171
Practice Address - Street 1:2311 OHIO AVE STE B
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-2559
Practice Address - Country:US
Practice Address - Phone:304-699-2373
Practice Address - Fax:888-972-5171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPO 074335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810025834Medicaid