Provider Demographics
NPI:1619254752
Name:PHILLIPS INTEGRATIVE HEALTH
Entity type:Organization
Organization Name:PHILLIPS INTEGRATIVE HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:860-405-1500
Mailing Address - Street 1:11 WICKLOW TURN
Mailing Address - Street 2:
Mailing Address - City:LEDYARD
Mailing Address - State:CT
Mailing Address - Zip Code:06339-1341
Mailing Address - Country:US
Mailing Address - Phone:860-464-2871
Mailing Address - Fax:
Practice Address - Street 1:801 POQUONNOCK RD
Practice Address - Street 2:SUITE 6
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4564
Practice Address - Country:US
Practice Address - Phone:860-405-1500
Practice Address - Fax:800-379-8041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036959261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care