Provider Demographics
NPI:1255955522
Name:PHILPOT, LESSIE THOMAS JR
Entity type:Individual
Prefix:MR
First Name:LESSIE
Middle Name:THOMAS
Last Name:PHILPOT
Suffix:JR
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 1:2130 N ARROWHEAD AVE STE 101I
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-4023
Mailing Address - Country:US
Mailing Address - Phone:773-243-6473
Mailing Address - Fax:
Practice Address - Street 1:228 E 34TH ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-2204
Practice Address - Country:US
Practice Address - Phone:773-243-6473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)