Provider Demographics
NPI:1417438862
Name:PHILLIPS, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:PHILLIPS
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 1:20655 FLEETWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-1625
Mailing Address - Country:US
Mailing Address - Phone:313-618-0694
Mailing Address - Fax:
Practice Address - Street 1:20655 FLEETWOOD DR
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1625
Practice Address - Country:US
Practice Address - Phone:313-618-0694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)