Basic Information
Provider Information
NPI: 1770849820
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PHILLIPS
FirstName: ANDREW
MiddleName: WAREJKO
NamePrefix: MR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5958
Address2:  
City: MCALLEN
State: TX
PostalCode: 785025958
CountryCode: US
TelephoneNumber: 9563628677
FaxNumber:  
Practice Location
Address1: 5501 S MCCOLL RD
Address2:  
City: EDINBURG
State: TX
PostalCode: 785395503
CountryCode: US
TelephoneNumber: 9563628677
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/03/2012
LastUpdateDate: 01/03/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/03/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XT3851TXN Allopathic & Osteopathic PhysiciansEmergency Medicine 
207LC0200XT3851TXY Allopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine

No ID Information.


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