Healthcare Provider Details

I. General information

NPI: 1902455355
Provider Name (Legal Business Name): PHIPPS FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 JUSTIN RD STE 104
HIGHLAND VILLAGE TX
75077-7182
US

IV. Provider business mailing address

34 REMINGTON DR W
HIGHLAND VILLAGE TX
75077-4006
US

V. Phone/Fax

Practice location:
  • Phone: 972-317-1400
  • Fax: 972-317-1477
Mailing address:
  • Phone: 469-261-8986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LOWELL PHIPPS
Title or Position: OWNER
Credential: MD
Phone: 469-261-8986