Provider Demographics
NPI:1376709345
Name:MICHAEL B PHILLIPS
Entity Type:Organization
Organization Name:MICHAEL B PHILLIPS
Other - Org Name:ONTARIO PROSTHETIC SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:909-466-4333
Mailing Address - Street 1:9253 HERMOSA AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5318
Mailing Address - Country:US
Mailing Address - Phone:909-466-4333
Mailing Address - Fax:909-466-7040
Practice Address - Street 1:9253 HERMOSA AVE
Practice Address - Street 2:SUITE C
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5318
Practice Address - Country:US
Practice Address - Phone:909-466-4333
Practice Address - Fax:909-466-7040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN/A1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5566240001Medicare NSC