Provider Demographics
NPI:1689244311
Name:PHILLIPS, MATTHEW PAUL
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PAUL
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 1:2240 N HWY 89 STE C
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84404-2824
Mailing Address - Country:US
Mailing Address - Phone:877-393-6232
Mailing Address - Fax:
Practice Address - Street 1:2240 N HWY 89 STE C
Practice Address - Street 2:
Practice Address - City:HARRISVILLE
Practice Address - State:UT
Practice Address - Zip Code:84404-2824
Practice Address - Country:US
Practice Address - Phone:877-393-6232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker