Provider Demographics
NPI:1861489569
Name:PHIPPS, NOEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:L
Last Name:PHIPPS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1303 AZALEA CT
Mailing Address - Street 2:STE C
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5765
Mailing Address - Country:US
Mailing Address - Phone:843-692-0570
Mailing Address - Fax:843-497-9566
Practice Address - Street 1:555 E CHEVES ST
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2617
Practice Address - Country:US
Practice Address - Phone:843-669-5162
Practice Address - Fax:843-667-4573
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2016-09-13
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Provider Licenses
StateLicense IDTaxonomies
SC268272085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD4049OtherMEDCOST
SC154758900OtherUS DEPT OF LABOR
SC570525838OtherSTANDARD TAX ID
SCP00133602OtherRAILROAD MEDICARE
SC154758900OtherFEDERAL BLACK LUNG
NC89067F5OtherNC MEDICAID
SC268277Medicaid
NC067F5OtherBCBS OF NC
NC89067F5OtherNC MEDICAID
SCH83814Medicare UPIN