Provider Demographics
NPI:1215280193
Name:PHILLIPS, CLIFF DELMAR
Entity type:Individual
Prefix:
First Name:CLIFF
Middle Name:DELMAR
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1358 MEADOWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3291
Mailing Address - Country:US
Mailing Address - Phone:330-531-6111
Mailing Address - Fax:330-531-6113
Practice Address - Street 1:6550 SEVILLE DR
Practice Address - Street 2:SUITE A
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9138
Practice Address - Country:US
Practice Address - Phone:330-531-6110
Practice Address - Fax:330-531-6113
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator