1578694980 NPI number — MRS. LAURA K PHILLIPS NURSE PRACTITIONER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578694980 NPI number — MRS. LAURA K PHILLIPS NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILLIPS
Provider First Name:
LAURA
Provider Middle Name:
K
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TOTH
Provider Other First Name:
LAURA
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
NURSE PRACTITIONER
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578694980
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
143 LONGWATER DRIVE
Provider Second Line Business Mailing Address:
SOUTH SHORE MEDICAL CENTER
Provider Business Mailing Address City Name:
NORWELL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02061-1795
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-878-5200
Provider Business Mailing Address Fax Number:
781-878-6750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
143 LONGWATER DR
Provider Second Line Business Practice Location Address:
SOUTH SHORE MEDICAL CENTER
Provider Business Practice Location Address City Name:
NORWELL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02061-1683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-878-5200
Provider Business Practice Location Address Fax Number:
781-878-6750
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  262089 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 042297845 . This is a "PHCS/MULTI-PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000065002 . This is a "MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 110085470A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: SS0070 . This is a "BCBSMA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 042297845 . This is a "TRICARD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1578694980 . This is a "FALLON HEALTH CARE" identifier . This identifiers is of the category "OTHER".




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