1730101155 NPI number — DR. CHARLES WILLIAM PHILLIPS M.D.

Table of content: JEROME B TAXY MD (NPI 1649322322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730101155 NPI number — DR. CHARLES WILLIAM PHILLIPS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILLIPS
Provider First Name:
CHARLES
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1730101155
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8001 FRANKLIN FARMS DR
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23229-5108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-521-5800
Provider Business Mailing Address Fax Number:
804-545-4340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7611 FOREST AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23229-4946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-288-4827
Provider Business Practice Location Address Fax Number:
804-288-4494
Provider Enumeration Date:
07/24/2006

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: 207RI0011X , with the licence number:  0101032041 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: 0101032041 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 276207 . This is a "ANTHEM/VA HEALTHKEEPERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 276304 . This is a "ANTHEM/VA HEALTHKEEPERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 56258 . This is a "SOUTHERN HEALTH SERVICES" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 60011755 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1426390 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 276237 . This is a "ANTHEM/VA HEALTHKEEPERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 44227 . This is a "SENTARA HEALTH/OPTIMA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 276363 . This is a "ANTHEM/VA HEALTHKEEPERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 311984 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 730149 . This is a "AETNA/US HEALTHCARE HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 90182 . This is a "ANTHEM/VA HEALTHKEEPERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 276278 . This is a "ANTHEM/VA HEALTHKEEPERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 25-00311 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 27413300 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 6056636 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4063662 . This is a "AETNA/US HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 103856 . This is a "ANTHEM/VA HEALTHKEEPERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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