MEDICARE: MRS. CINDY R PHILLIPS BSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1709	OTHER	KY	PRIMARY SERVICE COORDINAT

General Provider Information

NPI Number	:	1003992702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CINDY R PHILLIPS BSW

Provider Business Mailing Address
First Line	:	301 FALLS CREEK RD
Second Line	:
City	:	TORNADO
State	:	WV
Zip	:	25202-9533
Country	:	US
Telephone Number	:	606-547-1027
Fax Number	:	304-727-5340

Provider Business Practice Location Address
First Line	:	301 FALLS CREEK RD
Second Line	:
City	:	TORNADO
State	:	WV
Zip	:	25202-9533
Country	:	US
Telephone Number	:	606-547-1027
Fax Number	:	304-727-5340

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	02/22/2008

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