Healthcare Provider Details

I. General information

NPI: 1942488986
Provider Name (Legal Business Name): JANE PHILLIPS SPECIALTY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 SE DEBELL AVE BLDG B
BARTLESVILLE OK
74006-2343
US

IV. Provider business mailing address

PO BOX 1089
TULSA OK
74101-1089
US

V. Phone/Fax

Practice location:
  • Phone: 918-331-1090
  • Fax:
Mailing address:
  • Phone: 918-331-1090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: SCOTT PHILLIPS
Title or Position: PRESIDENT
Credential:
Phone: 918-331-1090