MEDICARE: LAUREN PHILLIPS L.AC, MSOM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	0852	AZ

General Provider Information

NPI Number	:	1891126694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN PHILLIPS L.AC, MSOM

Provider Business Mailing Address
First Line	:	5556 E FAIRMOUNT ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-4220
Country	:	US
Telephone Number	:	520-345-2886
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 N TUCSON BLVD
Second Line	:	SUITE 100
City	:	TUCSON
State	:	AZ
Zip	:	85716-3402
Country	:	US
Telephone Number	:	520-345-2886
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2013
Last Update Date	:	04/02/2017

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