Provider Demographics
NPI:1306823927
Name:PHILLIPS, MICHAEL SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 OAKMONT BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3908
Mailing Address - Country:US
Mailing Address - Phone:817-468-4343
Mailing Address - Fax:817-468-3438
Practice Address - Street 1:829 N NOLAN RIVER RD
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7085
Practice Address - Country:US
Practice Address - Phone:817-558-4600
Practice Address - Fax:817-468-3438
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2983207L00000X, 207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136902714OtherMEDICAID-00606K
TX8G7059OtherBCBS
TXP00160206OtherRAILROAD
TX136902717Medicaid
TX136902716OtherMEDICAID-00607K
TX8C0801OtherMEDICARE-00339K
TX8K7832OtherMEDICARE-00607K
TX136902713OtherMEDICAID-00339K
TX8D2510OtherMEDICARE-00606K
TXP00160206OtherRAILROAD
TX136902717Medicaid