Provider Demographics
NPI:1548200272
Name:CARE-A-VAN HOUSE CALLS PC
Entity Type:Organization
Organization Name:CARE-A-VAN HOUSE CALLS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DELANA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-441-9941
Mailing Address - Street 1:142 BEECH TREE TRL
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-3113
Mailing Address - Country:US
Mailing Address - Phone:252-441-9941
Mailing Address - Fax:252-441-9943
Practice Address - Street 1:142 BEECH TREE TRL
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-3113
Practice Address - Country:US
Practice Address - Phone:252-441-9941
Practice Address - Fax:252-441-9943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600229207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891192EMedicaid
NCCH7794OtherMEDICARE 'B' RAILROAD
NC67565OtherBCBS OF NC
NC891192EMedicaid
NCA53114Medicare UPIN
NC891192EMedicaid