Healthcare Provider Details

I. General information

NPI: 1013902709
Provider Name (Legal Business Name): GEORGE C PHILLIPS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 BROADWAY BLVD
KANSAS CITY MO
64111-2659
US

IV. Provider business mailing address

3101 BROADWAY BLVD PROVIDER ENROLLMENT DEPARTMENT
KANSAS CITY MO
64111-2659
US

V. Phone/Fax

Practice location:
  • Phone: 816-960-3070
  • Fax:
Mailing address:
  • Phone: 881-630-2370
  • Fax: 816-302-9939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2015022188
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-38278
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: