Provider Demographics
NPI:1568632032
Name:PHILCO INC
Entity Type:Organization
Organization Name:PHILCO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALLRED
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:936-291-2414
Mailing Address - Street 1:PO BOX 6073
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77342-6073
Mailing Address - Country:US
Mailing Address - Phone:936-291-2414
Mailing Address - Fax:936-438-8088
Practice Address - Street 1:1911 22ND ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4954
Practice Address - Country:US
Practice Address - Phone:936-291-2414
Practice Address - Fax:936-438-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50104291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX022377801Medicaid
TX022377801Medicaid