Organization
PHILLIP STATES, MD, FAMILY PRACTICE
Active
Organization
PHILLIP STATES, MD, FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILLIP J STATES MD (OWNER/PROPRIETOR)
(814) 938-3550
Entity
Organization
Contact information
Practice address
81 HILLCREST DR, SUITE 1300, PUNXSUTAWNEY, PA 15767-2605
(814) 938-3550
(814) 938-3679
Mailing address
81 HILLCREST DR, SUITE 1300, PUNXSUTAWNEY, PA 15767-2605
(814) 938-3550
(814) 938-3679
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
393918
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1019257860003
—
PA
01
—
393918
CMS CERTIFICATION NUMBER
PA
Enumeration date
02/25/2010
Last updated
12/20/2011
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