Phoenix Healthcare, LLC

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

License

216727 Issued in MA

Legal business name

PHOENIX HEALTHCARE, LLC

Practice address

61 Prospect St
Gloucester, MA 01930-5929

Phone

(617) 669-3171

NPI assigned

Oct 1, 2016

Organization subpart

No

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

Authorized official

Name

Yvonne Smikle, M.D.

Title

Owner/Member

Phone

(617) 669-3171

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1475280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475280000000",
    "number": "1679022651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 PROSPECT ST",
            "city": "GLOUCESTER",
            "state": "MA",
            "postal_code": "019305929",
            "telephone_number": "617-669-3171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 PROSPECT ST",
            "city": "GLOUCESTER",
            "state": "MA",
            "postal_code": "019305929",
            "telephone_number": "617-669-3171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-01",
        "last_updated": "2016-10-01",
        "status": "A",
        "authorized_official_last_name": "SMIKLE",
        "authorized_official_first_name": "YVONNE",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "617-669-3171",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "MA",
            "license": "216727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Anne Perrine
• Heather Perry
• Tara Petrocelli-McGloin, B.S.
• Miriam Pett, OTR/L
• Emily Philpott
• Gabriella Picariello
• Elizabeth Pierce
• Richard L Pinegar Jr., M.D.
• Tegan Mallary Polhamus, LICSW
• Conor Michael Powers

• Addiction Medicine (Family Medicine) Physician in Gloucester, MA
• Providers in Gloucester, MA by specialty
• Addiction Medicine (Family Medicine) Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2016; 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.