Provider Demographics
NPI:1447358155
Name:WINTERS, PHILIP J
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:J
Last Name:WINTERS
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 1:7381 MIDDLEPORT DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3560
Mailing Address - Country:US
Mailing Address - Phone:937-298-3111
Mailing Address - Fax:
Practice Address - Street 1:7381 MIDDLEPORT DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-3560
Practice Address - Country:US
Practice Address - Phone:937-298-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000000224OtherBLUE CROSS/BLUE SHIELD
OH0761813Medicaid
OH0546450001Medicare NSC