=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487811881
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATRICIA J. PHILLIPS, DO, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2008
-----------------------------------------------------
Last Update Date | 05/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 FOREST FALLS DR SUITE 11
-----------------------------------------------------
City | YARMOUTH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04096-6936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-847-9200
-----------------------------------------------------
Fax | 207-847-9315
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 FOREST FALLS DR SUITE 11
-----------------------------------------------------
City | YARMOUTH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04096-6936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-847-9200
-----------------------------------------------------
Fax | 207-847-9315
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROPRIETOR
-----------------------------------------------------
Name | DR. PATRICIA J PHILLIPS
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 207-847-9200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 1166
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------