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General NPI Number Information
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NPI Number | 1184875536
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Entity Type | Organization
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Legal Business Name | PHILLIPS FAMILY MEDICAL CENTER SC
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Dates
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Enumeration Date | 10/03/2008
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Last Update Date | 10/03/2008
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Provider Practice Location Address
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Address Line | 242 N YORK ST STE 106
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City | ELMHURST
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State | IL
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Zip | 60126-2746
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Country | US
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Telephone | 630-834-6245
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Fax | 630-834-3355
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Provider Business Mailing Address
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Address Line | 242 N YORK ST STE 106
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City | ELMHURST
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State | IL
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Zip | 60126-2746
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Country | US
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Telephone | 630-834-6245
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Fax | 630-834-3355
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OFELIA PHILLIPS
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Credential | M. D.
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Telephone | 630-834-6246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 042619348
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License Number State | IL
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