=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518276252
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CURTIS PHILLIPS DO PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2010
-----------------------------------------------------
Last Update Date | 09/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 428 S WILSON ST
-----------------------------------------------------
City | VINITA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74301-4246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-256-5021
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 439
-----------------------------------------------------
City | VINITA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74301-0439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CURTIS PHILLIPS
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 918-256-5021
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 3379
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 3379
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------