Provider Demographics
NPI:1710163258
Name:DR. LONETTE S PHIPPS, LLC
Entity Type:Organization
Organization Name:DR. LONETTE S PHIPPS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BENNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PHIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-788-8889
Mailing Address - Street 1:2152 46TH PLACE ENSLEY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35208-4602
Mailing Address - Country:US
Mailing Address - Phone:205-788-8889
Mailing Address - Fax:208-788-8890
Practice Address - Street 1:2152 46TH PLACE ENSLEY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35208-4602
Practice Address - Country:US
Practice Address - Phone:205-788-8889
Practice Address - Fax:208-788-8890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5045261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51538521OtherBLUE CROSS BLUE SHIELD