MEDICARE: MR. SIPHO PHILIPS RN, CEN

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	163WE0003X	Emergency Registered Nurse	729371	TX

General Provider Information

NPI Number	:	1619119526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SIPHO PHILIPS RN, CEN

Provider Business Mailing Address
First Line	:	8711 TOWN PARK DR
Second Line	:	# 2326
City	:	HOUSTON
State	:	TX
Zip	:	77036-2613
Country	:	US
Telephone Number	:	713-981-7560
Fax Number	:

Provider Business Practice Location Address
First Line	:	8711 TOWN PARK DR
Second Line	:	# 2326
City	:	HOUSTON
State	:	TX
Zip	:	77036-2613
Country	:	US
Telephone Number	:	713-981-7560
Fax Number	:

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

Provider Enumeration Date	:	03/24/2009
Last Update Date	:	03/24/2009

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