Provider Demographics
NPI:1184875536
Name:PHILLIPS FAMILY MEDICAL CENTER SC
Entity type:Organization
Organization Name:PHILLIPS FAMILY MEDICAL CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OFELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:630-834-6246
Mailing Address - Street 1:242 N YORK ST STE 106
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2746
Mailing Address - Country:US
Mailing Address - Phone:630-834-6245
Mailing Address - Fax:630-834-3355
Practice Address - Street 1:242 N YORK ST STE 106
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2746
Practice Address - Country:US
Practice Address - Phone:630-834-6245
Practice Address - Fax:630-834-3355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042619348207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty