Provider Demographics
NPI:1891706867
Name:PHILLIPS, CHRISTOPHER E (PAC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:E
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623
Mailing Address - Country:US
Mailing Address - Phone:419-479-5820
Mailing Address - Fax:440-988-1225
Practice Address - Street 1:4235 SECOR RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4231
Practice Address - Country:US
Practice Address - Phone:419-479-5820
Practice Address - Fax:419-479-5821
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2339363AM0700X
OH50002339363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0236248Medicaid
OHPA27312Medicare PIN
OH9284951Medicare PIN
OH0236248Medicaid
OHQ71450Medicare UPIN
OHPHPA27317Medicare PIN
OHPA27316Medicare PIN