Provider Demographics
NPI:1881883320
Name:PHYLLIS A CULLEN MD INC
Entity type:Organization
Organization Name:PHYLLIS A CULLEN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:CULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-895-3287
Mailing Address - Street 1:PO BOX 1477
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96721-1477
Mailing Address - Country:US
Mailing Address - Phone:530-895-3287
Mailing Address - Fax:
Practice Address - Street 1:274 COHASSET RD
Practice Address - Street 2:SUITE 110
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2236
Practice Address - Country:US
Practice Address - Phone:530-891-0325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06195ZOtherMEDICARE GROUP PTAN
CA00G324032OtherMEDICARE INDIVIDUAL PTAN