1164515821 NPI number — PHILLIPS & ROSE, PC

Table of content: (NPI 1164515821)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164515821 NPI number — PHILLIPS & ROSE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHILLIPS & ROSE, PC
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:
DRS. PHILLIPS, ROSE & ASSOCIATES
Provider Other Organization Name Type Code:
3
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:
1164515821
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7580 HOSPITAL DR
Provider Second Line Business Mailing Address:
SUTIE 201
Provider Business Mailing Address City Name:
GLOUCESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-693-0810
Provider Business Mailing Address Fax Number:
804-693-0211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7580 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUTIE 201
Provider Business Practice Location Address City Name:
GLOUCESTER
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-693-0810
Provider Business Practice Location Address Fax Number:
804-693-0211
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PHILLIPS
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PRESIDENT/MEDICAL DIRECTOR
Authorized Official Telephone Number:
804-693-0810

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  0701003186 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YP2500X , with the licence number: 0701001615 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103T00000X , with the licence number: 0810001810 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103TC0700X , with the licence number: 01077001643 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X , with the licence number: 0904001475 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X , with the licence number: 0904002000 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X , with the licence number: 0701001424 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 174400000X , with the licence number: 0101033004 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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