Little Kanawha Family Medicine PLLC
Organization Active NPI Family Medicine Physician · Glenville, WV
NPI 1295770600 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1295770600
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 1999 (WV)
- Legal business name
- LITTLE KANAWHA FAMILY MEDICINE PLLC
- Practice address
- 604 W Main St
Glenville, WV 26351 - Phone
- (304) 462-7460
- Fax
- (304) 462-7461
- NPI assigned
- Jun 19, 2006
- Organization subpart
- No
Authorized official
- Name
- Hillary D Miller, DO MPH
- Title
- Owner Physician
- Phone
- (304) 462-7460
Practitioners 2
-
Eddie Evan Anderson, D.O.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 51D1041679 | Little Kanawha Family Medicine | Certificate of waiver | Jun 8, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050525001255 | WV | Part B Supplier - Clinic/Group Practice | 9335181759 |
Receives reassigned benefits from 2 practitioners Practice locations: Glenville, WV |
National Provider Directory
Locations
604 W Main St
Glenville, WV 26351
Phone (304) 462-7460
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 1999 | WV | Yes |
Addresses
Primary practice location
604 W Main St
Glenville, WV 26351
Mailing address
604 W Main St
Glenville, WV 26351
Phone (304) 462-7460
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810002135 | Medicaid | WV |
Other providers in Glenville, WV
- Robin King
- Todd A. Lares
- Jeanette Ellen Leal
- Susan Quinn Lilly
- Heidi Lynn Lindsay
- Jamie Losh
- Peggy Losh
- Abbie Jo Lowther
- Sandra Luzader
- Mark J Cinalli OD Faao PLLC
All providers in Glenville, WV · Family Medicine Physician in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.