Provider Demographics
NPI:1033183959
Name:PHILLIPS AND LEVITT SURGICAL ASSOC INC
Entity Type:Organization
Organization Name:PHILLIPS AND LEVITT SURGICAL ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:W
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-364-8011
Mailing Address - Street 1:340 OXFORD ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-1967
Mailing Address - Country:US
Mailing Address - Phone:330-364-8011
Mailing Address - Fax:330-364-0058
Practice Address - Street 1:340 OXFORD ST
Practice Address - Street 2:SUITE 220
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-1967
Practice Address - Country:US
Practice Address - Phone:330-364-8011
Practice Address - Fax:330-364-0058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0646330OtherAETNA
16768029200OtherOBWC
289447245005OtherMEDICAL MUTUAL OF OH
203602824002OtherMEDICAL MUTUAL OF OH
7436728OtherAETNA
000000365717OtherANTHEM
000000139927OtherANTHEM
0658677OtherAETNA
167680292001OtherMEDICAL MUTUAL OF OH
20360282400OtherOBWC
000000139928OtherANTHEM
I78880OtherRR MEDICARE
28944724500OtherOBWC
0658677OtherAETNA
167680292001OtherMEDICAL MUTUAL OF OH
=========AOtherAULTCARE
20360282400OtherOBWC
289447245005OtherMEDICAL MUTUAL OF OH