Provider Demographics
NPI:1699891424
Name:MILLER PEDIATRICS, P.A.
Entity type:Organization
Organization Name:MILLER PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:254-918-2484
Mailing Address - Street 1:103 E FREY ST
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-2603
Mailing Address - Country:US
Mailing Address - Phone:254-918-2484
Mailing Address - Fax:254-965-3294
Practice Address - Street 1:103 E FREY ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-2603
Practice Address - Country:US
Practice Address - Phone:254-918-2484
Practice Address - Fax:254-965-3294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6487261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPO87083J2Medicaid
TXH17772Medicare UPIN
TXPO87083J2Medicaid