William Morgan Miller, PA
Individual provider Active NPI Medical Physician Assistant · Evarts, KY
NPI 1720070089 · NPPES record last updated Jul 30, 2010
Key facts
- NPI
- 1720070089
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- PA-388 (KY)
- Practice address
- 101 Chad St
Evarts, KY 40828-0039 - Phone
- (606) 837-2108
- Fax
- (606) 837-2111
- NPI assigned
- Aug 22, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110718000660 | KY | Practitioner - Physician Assistant | 7810165800 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-388 | KY | MD | Medical Physician Assistant |
| PA388 | KY | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clover Fork Outpatient Medical Project Inc | Current |
Accepting new patients |
Locations
101 Chad St
Evarts, KY 40828
Phone (606) 837-2108
209 E Mound St
Harlan, KY 40831
Phone (606) 573-1975
420 E Central St
Harlan, KY 40831
Phone (606) 573-8700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA388 | KY | |
| Medical Physician Assistant | 363AM0700X | PA-388 | KY | Yes |
Addresses
Primary practice location
101 Chad St
Evarts, KY 40828-0039
Mailing address
PO Box 39
Evarts, KY 40828-0039
Phone (606) 837-2108
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 95002606 | Medicaid | KY |
Other providers in Evarts, KY
- Sharon M Colton
- Cumberland Valley Dist. Health Dept.
- Discreet Therapy Services LLC.
- Rachel R Eubank
- Barbara Kaye Middleton
- My Time Counseling Services for Professionals, P.L.L.C.
- Jarrod Bradley Napier
- Michael W Napier
- Eric N Roberts
- Mia R Sellars
All providers in Evarts, KY · Medical Physician Assistant in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 30, 2010. 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.