Provider Demographics
NPI:1235653882
Name:PHILLIPS MEDICINE LLC
Entity Type:Organization
Organization Name:PHILLIPS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:501-397-2604
Mailing Address - Street 1:PO BOX 20146
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71612-0146
Mailing Address - Country:US
Mailing Address - Phone:501-397-2604
Mailing Address - Fax:501-397-2645
Practice Address - Street 1:1011 SHERIDAN ROAD
Practice Address - Street 2:
Practice Address - City:REDFIELD
Practice Address - State:AR
Practice Address - Zip Code:72132
Practice Address - Country:US
Practice Address - Phone:501-397-2604
Practice Address - Fax:501-397-2645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-26
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care