Active NPI
Monell Phillips
- Other Technician
- Titusville, FL
National Provider Identifier
1093068504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- Practice address
- 1850 S Deleon Ave
Titusville, FL 32780-7733 - Phone
- (321) 264-5000
- NPI assigned
- Oct 22, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | FL | Primary |
Addresses
Primary practice location
1850 S Deleon Ave
Titusville, FL 32780-7733
Mailing address
1850 S Deleon Ave
Titusville, FL 32780-7733
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001165600 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350864000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350864000000",
"number": "1093068504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1850 S DELEON AVE",
"city": "TITUSVILLE",
"state": "FL",
"postal_code": "327807733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1850 S DELEON AVE",
"city": "TITUSVILLE",
"state": "FL",
"postal_code": "327807733",
"telephone_number": "321-264-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "MONELL",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-10-22",
"last_updated": "2012-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "FL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001165600",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Titusville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.