Provider Demographics
NPI:1134486277
Name:PHILLIPS, STERLING KENTON (LP, CP)
Entity Type:Individual
Prefix:
First Name:STERLING
Middle Name:KENTON
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:LP, CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 19TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-2408
Mailing Address - Country:US
Mailing Address - Phone:806-799-1518
Mailing Address - Fax:806-799-5462
Practice Address - Street 1:4421 19TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2408
Practice Address - Country:US
Practice Address - Phone:806-799-1518
Practice Address - Fax:806-799-5462
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX221224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145567702Medicaid
4170880001Medicare NSC