Provider Demographics
NPI:1225307622
Name:DR. PHILLIPS MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:DR. PHILLIPS MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:D.
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-370-2772
Mailing Address - Street 1:7450 DR PHILLIPS BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5120
Mailing Address - Country:US
Mailing Address - Phone:407-370-2772
Mailing Address - Fax:407-370-2770
Practice Address - Street 1:7450 DR PHILLIPS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5120
Practice Address - Country:US
Practice Address - Phone:407-370-2772
Practice Address - Fax:407-370-2770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty