Provider Demographics
NPI:1689854549
Name:JOHN W PHIPPS
Entity Type:Organization
Organization Name:JOHN W PHIPPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:PHIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-739-8616
Mailing Address - Street 1:1133 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-2806
Mailing Address - Country:US
Mailing Address - Phone:607-739-8616
Mailing Address - Fax:607-739-1655
Practice Address - Street 1:1133 WILLOW ST
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-2806
Practice Address - Country:US
Practice Address - Phone:607-739-8616
Practice Address - Fax:607-739-1655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1B000002124OtherBLUE CROSS/ BLUE SHEILD
PA1201264Medicaid
NY01793553Medicaid
0849360001Medicare NSC