Active NPI
Demetria D Phillips
- Prosthetic/Orthotic Supplier
- Houston, TX
National Provider Identifier
1740900612
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetic/Orthotic Supplier
- License
- 1602217
- Practice address
- 5215 FM 1960 Rd W
Houston, TX 77069-4414 - Phone
- (337) 570-0712
- NPI assigned
- Aug 31, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prevention Professional | 405300000X | 1602217 | TX | |
| Prosthetic/Orthotic Supplier | 335E00000X | 1602217 | TX | Primary |
Addresses
Primary practice location
5215 FM 1960 Rd W
Houston, TX 77069-4414
Mailing address
10144 Wild Hollow LN
Houston, TX 77088-2150
Phone (337) 570-0712
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1602217 | TX | MD | Prevention Professional |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661904000000",
"number": "1740900612",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10144 WILD HOLLOW LN",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770882150",
"telephone_number": "337-570-0712"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5215 FM 1960 RD W",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770694414",
"telephone_number": "337-570-0712"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "DEMETRIA",
"middle_name": "D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-08-31",
"last_updated": "2022-08-31",
"certification_date": "2022-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "405300000X",
"taxonomy_group": "",
"desc": "Prevention Professional",
"state": "TX",
"license": "1602217",
"primary": false
},
{
"code": "335E00000X",
"taxonomy_group": "",
"desc": "Prosthetic/Orthotic Supplier",
"state": "TX",
"license": "1602217",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.