1568796258 NPI number — MS. PHYLLIS P PHILLIPS MMT, CHT

Table of content: MS. PHYLLIS P PHILLIPS MMT, CHT (NPI 1568796258)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568796258 NPI number — MS. PHYLLIS P PHILLIPS MMT, CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILLIPS
Provider First Name:
PHYLLIS
Provider Middle Name:
P
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MMT, CHT
Provider Gender Code:
F

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:
1568796258
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1895 YOUNGFIELD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOLDEN
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80401-3556
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-279-6237
Provider Business Mailing Address Fax Number:
303-277-9789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1895 YOUNGFIELD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOLDEN
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80401-3556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-279-6237
Provider Business Practice Location Address Fax Number:
303-277-9789
Provider Enumeration Date:
09/28/2009

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: 225700000X , with the licence number:  7178 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com