Provider Demographics
NPI:1518783224
Name:NEVILLE, PHIL CHARLES
Entity type:Individual
Prefix:
First Name:PHIL
Middle Name:CHARLES
Last Name:NEVILLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4352 CYPRESS SHORES DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619-9723
Mailing Address - Country:US
Mailing Address - Phone:678-346-1566
Mailing Address - Fax:
Practice Address - Street 1:4352 CYPRESS SHORES DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36619-9723
Practice Address - Country:US
Practice Address - Phone:678-346-1566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00000000343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)