Provider Demographics
NPI:1033182290
Name:PHILLIPS, ROBERT A JR (MD, MBA, FACS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:PHILLIPS
Suffix:JR
Gender:M
Credentials:MD, MBA, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2370
Mailing Address - Country:US
Mailing Address - Phone:785-625-4699
Mailing Address - Fax:785-261-7424
Practice Address - Street 1:2220 CANTERBURY DR
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2370
Practice Address - Country:US
Practice Address - Phone:785-625-4699
Practice Address - Fax:785-261-7424
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42638208G00000X
SC21559208G00000X
KS0442249208G00000X
VA0101258035208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1033182290Medicaid
SC215591Medicaid
SCA99694Medicare UPIN
VA1033182290Medicaid
SC215591Medicaid
VAVVK655AMedicare PIN
KY00979001Medicare PIN