Randy King Miller, D.O.
Individual provider Active NPI Family Medicine Physician · Shell Knob, MO
NPI 1003968058 · NPPES record last updated Dec 28, 2010
Key facts
- NPI
- 1003968058
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MO115530 (MO)
- Practice address
- 25376 State Highway 39
Ste 301
Shell Knob, MO 65747-7343 - Phone
- (417) 236-2680
- Fax
- (417) 236-2683
- NPI assigned
- Jan 18, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MO115530 | MO | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gibson Community Hospital Association | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MO115530 | MO | Yes |
Addresses
Primary practice location
25376 State Highway 39
Ste 301
Shell Knob, MO 65747-7343
Mailing address
3800 S National Ave
Ste 540
Springfield, MO 65807-5209
Phone (417) 269-5712
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 249997503 | Medicaid | MO |
Other providers in Shell Knob, MO
- Lester E Cox Medical Centers
- Lester E. Cox Medical Centers
- Robert Eugene McDougle
- Mercy Clinic-Springfield Communities
- Mercy Hospital Springfield
- Michelle Gail O'Connell
- Ozarks Regions Health Systems
- Angie Pittser
- Regional Services
- Shell Knob Pharmacy LLC
All providers in Shell Knob, MO · Family Medicine Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 28, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.