Basic Information
| Provider Information | |||||||||
| NPI: | 1255394300 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OVERMILLER | ||||||||
| FirstName: | CARL | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 587 | ||||||||
| Address2: | |||||||||
| City: | RIPLEY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 252710587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043730133 | ||||||||
| FaxNumber: | 3043730497 | ||||||||
| Practice Location | |||||||||
| Address1: | 122 PINNELL ST | ||||||||
| Address2: | |||||||||
| City: | RIPLEY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 252719101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043730133 | ||||||||
| FaxNumber: | 3043731598 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 01/28/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 17934 | WV | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 437312 | 01 | WV | CARELINK | OTHER | 794702 | 01 | WV | FIRST HEALTH | OTHER | 2697550 | 05 | OH | MEDICAID | 010299772 | 05 | VA | MEDICAID | 57898 | 01 | WV | UNICARE | OTHER | 1801280000 | 05 | WV | MEDICAID | 4539316 | 01 | WV | AETNA | OTHER | 000787284 | 01 | WV | MOUNTAIN BCBS | OTHER | 2243174 | 01 | WV | CIGNA | OTHER |