1316123714 NPI number — C. VINCENT PHILLIPS, M.D., INC.

Table of content: (NPI 1316123714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316123714 NPI number — C. VINCENT PHILLIPS, M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
C. VINCENT PHILLIPS, M.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316123714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3838 SAN DIMAS ST
Provider Second Line Business Mailing Address:
SUITE B-231
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93301-2284
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-665-0505
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3838 SAN DIMAS ST
Provider Second Line Business Practice Location Address:
SUITE B-231
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93301-2284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-665-0505
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/15/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PHILLIPS
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
VINCENT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
661-665-0505

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  C37044 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2086S0129X , with the licence number: C37044 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GR0062760 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020000590 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ43503Z . This is a "MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".