Provider Demographics
NPI:1649230343
Name:PHILLIPS, THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
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 1:947 S IRBY ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5238
Mailing Address - Country:US
Mailing Address - Phone:843-665-9581
Mailing Address - Fax:
Practice Address - Street 1:1590 FREEDOM BLVD
Practice Address - Street 2:STE. B
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6071
Practice Address - Country:US
Practice Address - Phone:843-665-9581
Practice Address - Fax:843-669-6426
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7331207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC073315Medicaid
SC4255295OtherAETNA
SC470890494OtherSTANDARD TAX ID
SC073315Medicaid
SCE2755OtherMEDCOST
SC0700481OtherCAROLINA CARE PLAN
SC0700481OtherCAROLINA CARE PLAN
SCD906118269Medicare PIN
SCD90611Medicare UPIN
NC073315Medicaid