Provider Demographics
NPI:1790392090
Name:PHILLIPS, MATTHEW GARFIELD
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GARFIELD
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:PO BOX 907
Mailing Address - Street 2:
Mailing Address - City:CRAIGSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26205-0907
Mailing Address - Country:US
Mailing Address - Phone:304-618-7966
Mailing Address - Fax:
Practice Address - Street 1:95 T AND K ACRES
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-9539
Practice Address - Country:US
Practice Address - Phone:304-618-7966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant