1871501411 NPI number — DR. MATTHEW W PHILLIPS M.D.

Table of content: DR. MATTHEW W PHILLIPS M.D. (NPI 1871501411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871501411 NPI number — DR. MATTHEW W PHILLIPS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILLIPS
Provider First Name:
MATTHEW
Provider Middle Name:
W
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:
1871501411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
340 OXFORD STREET
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
DOVER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44622-1967
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-364-8011
Provider Business Mailing Address Fax Number:
330-364-0058

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
340 OXFORD STREET
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44622-1967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-364-8011
Provider Business Practice Location Address Fax Number:
330-364-0058
Provider Enumeration Date:
08/03/2006

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: 174400000X , with the licence number:  35-052082 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 341832667 . This is a "STANDARD TAX ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: I7880 . This is a "RR GROUP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0697938 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020042125 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0646330 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000139928 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2080966 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: I700421 . This is a "UNITED HEALTHCARE IND" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 341832667A . This is a "AULTCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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