| Organization Name: | PHILLIP STATES, MD, FAMILY PRACTICE |
| NPI Number: | 1376865816 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PHILLIP J STATES (OWNER/PROPRIETOR) |
| Mailing Address: | 81 Hillcrest Dr Suite 1300 Punxsutawney |
| State: | PA US |
| Postal Code: | 157672605 |
| Phone Number: | 8149383550 |
| Fax Number: | 8149383679 |
| NPI Enumeration Date: | 02/25/2010 |
| NPI Last Update Date: | 12/20/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | 393918 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |