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General NPI Number Information
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NPI Number | 1154612588
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Entity Type | Individual
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Provider Name | PHILLIP KELCHEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/19/2011
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 1000 E PRIMROSE ST
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City | SPRINGFIELD
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State | MO
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Zip | 65807-5154
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Country | US
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Telephone | 417-269-9812
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Fax | 417-269-9966
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Provider Business Mailing Address
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Address Line | PO BOX 4046
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City | SPRINGFIELD
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State | MO
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Zip | 65808-4046
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Country | US
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Telephone | 417-269-5712
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Fax | 417-269-7567
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2014007878
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License Number State | MO
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