Provider Demographics
NPI:1467846253
Name:PHILLIPS HEALTHCARE GROUP, PC
Entity Type:Organization
Organization Name:PHILLIPS HEALTHCARE GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:423-273-0741
Mailing Address - Street 1:PO BOX 879
Mailing Address - Street 2:
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-0879
Mailing Address - Country:US
Mailing Address - Phone:423-839-2120
Mailing Address - Fax:423-839-2125
Practice Address - Street 1:6890 W.A.J. HWY.
Practice Address - Street 2:
Practice Address - City:TALBOTT
Practice Address - State:TN
Practice Address - Zip Code:37877
Practice Address - Country:US
Practice Address - Phone:423-839-2120
Practice Address - Fax:423-839-2125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD024822207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1396184222OtherNPI NUMBER
TN1942297916OtherNPI NUMBER
TN1528003886OtherNPI NUMBER