=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255513453
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHILLIPS HOSPITAL COMPANY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2007
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 MARTIN LUTHER KING JR DR
-----------------------------------------------------
City | HELENA
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72342-8998
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-338-5800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1801 MARTIN LUTHER KING JR DR
-----------------------------------------------------
City | HELENA
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72342-8998
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-816-3900
-----------------------------------------------------
Fax | 870-816-3909
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PROVIDER ENROLLMENT
-----------------------------------------------------
Name | WILLIAM TAYLOR MARSHALL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-465-7626
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------