Healthcare Provider Details

I. General information

NPI: 1356057384
Provider Name (Legal Business Name): ZACHARY IAN PHILLIPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 DIMMITT RD
PLAINVIEW TX
79072-1833
US

IV. Provider business mailing address

306 MESA CIR
PLAINVIEW TX
79072-6508
US

V. Phone/Fax

Practice location:
  • Phone: 806-296-5531
  • Fax:
Mailing address:
  • Phone: 276-345-2729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1021234
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: