Phillips Integrative Health

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

036959 Issued in CT

Legal business name

PHILLIPS INTEGRATIVE HEALTH

Practice address

801 Poquonnock Rd
Suite 6
Groton, CT 06340-4564

Phone

(860) 405-1500

Fax

(800) 379-8041

NPI assigned

Nov 3, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Harold Eugene Phillips Jr., M.D.

Title

Owner

Phone

(860) 405-1500

Specialties & licenses 1

Addresses

Other names 1

• MOUNT MORIAH MEDICAL CENTER Former legal business name

Tax ID family

Mount Moriah Medical Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Mount Moriah Medical Center, LLC

  • Family Medicine Physician
  • New London, CT
  • NPI 1558308445
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1320278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320278400000",
    "number": "1619254752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 WICKLOW TURN",
            "city": "LEDYARD",
            "state": "CT",
            "postal_code": "063391341",
            "telephone_number": "860-464-2871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 POQUONNOCK RD",
            "address_2": "SUITE 6",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063404564",
            "telephone_number": "860-405-1500",
            "fax_number": "800-379-8041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILLIPS INTEGRATIVE HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-03",
        "last_updated": "2011-11-03",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "HAROLD",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-405-1500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CT",
            "license": "036959",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MOUNT MORIAH MEDICAL CENTER",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Kenneth R Peterson, D.C.
• Lauren Pettit, BS
• Kristin Pezzolesi, RDH
• Phalanx Med Connecticut, LLC
• David Phelps Jr., DDS
• Christopher Phillips, IDC
• Laura Schmitt Phillips, BCTMB, LMT
• Physical Therapy of Mystic, LLC
• Janine M Pilney, LADC
• Pink Mermaid LLC

• Primary Care Clinic/Center in Groton, CT
• Providers in Groton, CT by specialty
• Primary Care Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.