MR. MARIO DELANO PHILLIPS JR.


Address: 745 Eden Way North, Chesapeake, VA 23320
Phone: 7575602457

MR. MARIO DELANO PHILLIPS JR. (NPI# 1336582774) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1336582774
Entity Type Individual
Full Name MR. MARIO DELANO PHILLIPS JR.
Credential IDC
Practice Address 745 Eden Way North
Chesapeake
VA 23320
Mailing Address Marine Corps Security Forces
Mca 614 Port Au Prince
Norfolk
VA 23551-0001
Practice Telephone 7575602457
Mailing Telephone 7574446492
Enumeration Date 2013-04-16
Last Update Date 2013-04-16
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 1710I1002X Military Health Care Provider
Specialization: Independent Duty Corpsman
Other Service Providers

Office Location

Street Address 745 EDEN WAY NORTH
City CHESAPEAKE
State VA
Zip Code 23320

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Taxonomy Information

Taxonomy Code 1710I1002X
Grouping Other Service Providers
Classification Military Health Care Provider
Specialization Independent Duty Corpsman

Taxonomy Definition

A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals.
Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1346661550 Angel Daniel Rendon Military Health Care Provider 865 Royal Grove Ct, Chesapeake, VA 23320-6564 2013-12-16
1366872772 Matthew John Watton Military Health Care Provider 1414 Sabbath Ln, Chesapeake, VA 23320-3348 2013-11-21
1932533601 Ernesto Carrasquillo IIi Military Health Care Provider 1804 Crestmont Place, Apt 302, Chesapeake, VA 23320 2013-08-29
1871845313 Jennifer Renee Otterbach Military Health Care Provider 4000 Hailey Ct, Chesapeake, VA 23321-3137 2012-10-08
1588925754 Christian Marsh Military Health Care Provider 707 Washington Dr, Chesapeake, VA 23322-7327 2012-06-05
1982977153 Michael Thomas Hedden Military Health Care Provider 1317 Richwood Ave, Chesapeake, VA 23323-5746 2012-02-17
1801126289 Daniel Michael Covitz Military Health Care Provider 1317 Ballahack Rd. Ste 100, Capt W.l. Mcgonagle Branch Clinic Nsa Northwest, Chesapeake, VA 23322-2463 2010-01-06
1538319223 Christopher Golden Military Health Care Provider 201 Thoroughbred Ln, Chesapeake, VA 23320-3061 2008-09-30
1902069990 Huben Lindale Phillips Military Health Care Provider 2803 Meadow Wood Ct W, Chesapeake, VA 23321-4228 2008-07-09
1649439605 Louis Eugene Raiford Military Health Care Provider 217 Heritage Oak Dr, Chesapeake, VA 23320-9501 2008-06-05
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Competitor

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City CHESAPEAKE
Zip Code 23320

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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