Healthcare Provider Details

I. General information

NPI: 1780451823
Provider Name (Legal Business Name): WILLIAM ROBERT HUNTER PHILLIPS CHW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N FRANKLIN ST
CUBA MO
65453-1717
US

IV. Provider business mailing address

330 N FRANKLIN ST
CUBA MO
65453-1717
US

V. Phone/Fax

Practice location:
  • Phone: 573-885-0885
  • Fax: 573-677-0567
Mailing address:
  • Phone: 573-885-0885
  • Fax: 573-677-0567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number15794
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number2014043120
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: