Healthcare Provider Details

I. General information

NPI: 1508150830
Provider Name (Legal Business Name): THOMAS PHILLIPS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 WOLLARD BLVD
RICHMOND MO
64085-2229
US

IV. Provider business mailing address

9411 N OAK TRFY STE LL1
KANSAS CITY MO
64155-2262
US

V. Phone/Fax

Practice location:
  • Phone: 816-776-2201
  • Fax: 816-776-7678
Mailing address:
  • Phone: 816-691-1655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number04-37926
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2015028100
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: