Provider Demographics
NPI:1033731716
Name:PHILLIP, PIUS R
Entity Type:Individual
Prefix:
First Name:PIUS
Middle Name:R
Last Name:PHILLIP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ANDERSON STREET CLINIC ROAD
Mailing Address - Street 2:
Mailing Address - City:ALAKANUK
Mailing Address - State:AK
Mailing Address - Zip Code:99554
Mailing Address - Country:US
Mailing Address - Phone:907-238-3151
Mailing Address - Fax:907-238-3706
Practice Address - Street 1:101 ANDERSON STREET CLINIC ROAD
Practice Address - Street 2:
Practice Address - City:ALAKANUK
Practice Address - State:AK
Practice Address - Zip Code:99554
Practice Address - Country:US
Practice Address - Phone:907-238-3151
Practice Address - Fax:907-238-3706
Is Sole Proprietor?:No
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker