Phillip D. Courtney
Individual provider Active NPI Home Modifications Contractor · Chugiak, AK
NPI 1497028526 · NPPES record last updated Feb 21, 2012
Key facts
- NPI
- 1497028526
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Home Modifications Contractor 171WH0202X
- License
- 24301 (AK)
- Practice address
- 18708 Sue Tawn Drive
Chugiak, AK 99567 - Phone
- (907) 688-0731
- NPI assigned
- Feb 21, 2012
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24301 | AK | MD | Home Modifications Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | |||
| Home Modifications Contractor | 171WH0202X | 24301 | AK | Yes |
| Vehicle Modifications Contractor | 171WV0202X |
Addresses
Primary practice location
18708 Sue Tawn Drive
Chugiak, AK 99567
Mailing address
PO Box 670811
Chugiak, AK 99567-0811
Phone (907) 688-0731
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| EM4435 | Medicaid | AK |
Other providers in Chugiak, AK
- Chugiak Volunteer Fire & Rescue Inc
- Glenn Matthew Clare
- Caryn Sue Clements
- Chae A Colbert
- Berrie Colyar
- Deanna Kay Cresap
- Hayden J Crist
- Lilian Alison Crites-Flesher
- CS Wellness, LLC
- Bonnie Curl
All providers in Chugiak, AK · Home Modifications Contractor in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 21, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.