Provider Demographics
NPI:1265434484
Name:PHILLIPS CLINIC CORPORATION
Entity type:Organization
Organization Name:PHILLIPS CLINIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-309-3340
Mailing Address - Street 1:330 FRANKLIN ROAD #135A- 196
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-309-3300
Mailing Address - Fax:615-309-3338
Practice Address - Street 1:330 FRANKLIN ROAD #135A- 196
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027
Practice Address - Country:US
Practice Address - Phone:615-309-3300
Practice Address - Fax:615-309-3338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty