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General NPI Number Information
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NPI Number | 1306396007
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Entity Type | Organization
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Legal Business Name | PHILLIPS FAMILY MEDICINE CLINIC LLC
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Dates
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Enumeration Date | 10/06/2016
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Last Update Date | 05/08/2024
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Provider Practice Location Address
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Address Line | 2 MEDICAL PLAZA PL
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City | MINDEN
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State | LA
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Zip | 71055-3330
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Country | US
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Telephone | 318-382-9401
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Fax | 318-382-9403
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Provider Business Mailing Address
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Address Line | 2 MEDICAL PLAZA PL
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City | MINDEN
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State | LA
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Zip | 71055-3330
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Country | US
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Telephone | 318-382-9401
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Fax | 318-382-9403
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Authorized Official
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Title or Position | OWNER
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Name | DR. GREGORY SCOTT PHILLIPS
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Credential | M.D.
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Telephone | 318-382-9401
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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 | 023191
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License Number State | LA
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