Provider Demographics
NPI: | 1679980197 |
---|---|
Name: | RP HEALTH |
Entity Type: | Organization |
Organization Name: | RP HEALTH |
Other - Org Name: | ROXANNA PHILLIPS MD SOLE MBR |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | MANAGER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | RONALD |
Authorized Official - Middle Name: | C |
Authorized Official - Last Name: | PHILLIPS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 702-773-3305 |
Mailing Address - Street 1: | PO BOX 1395 |
Mailing Address - Street 2: | |
Mailing Address - City: | ELEPHANT BUTTE |
Mailing Address - State: | NM |
Mailing Address - Zip Code: | 87935-1395 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 702-773-3305 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 518 N DATE ST |
Practice Address - Street 2: | |
Practice Address - City: | TRUTH OR CONSEQUENCES |
Practice Address - State: | NM |
Practice Address - Zip Code: | 87901-2346 |
Practice Address - Country: | US |
Practice Address - Phone: | 575-744-5112 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-07-16 |
Last Update Date: | 2014-07-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NM | MD2012-0533 | 208000000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Single Specialty |