Healthcare Provider Details

I. General information

NPI: 1821270950
Provider Name (Legal Business Name): LANA I PHILLIPS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 MAIN ST
BEVERLY WV
26253-9759
US

IV. Provider business mailing address

328 MAIN ST
BEVERLY WV
26253-9759
US

V. Phone/Fax

Practice location:
  • Phone: 304-637-2567
  • Fax:
Mailing address:
  • Phone: 304-637-2567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number070820
License Number StateWV

VIII. Authorized Official

Name: MS. LANA I PHILLIPS
Title or Position: OWNER
Credential:
Phone: 304-637-2567