Healthcare Provider Details

I. General information

NPI: 1013285071
Provider Name (Legal Business Name): RUSSELL GLENN PHILLIPS HEARING SPECIALIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 JAMES SANDERS BLVD
PADUCAH KY
42001-9159
US

IV. Provider business mailing address

8045 OGDEN LANDING RD
WEST PADUCAH KY
42086-9623
US

V. Phone/Fax

Practice location:
  • Phone: 270-558-7112
  • Fax: 502-352-2472
Mailing address:
  • Phone: 270-558-7112
  • Fax: 270-444-6923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number101279
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: