MEDICARE: MR. STEVEN PHILLIPS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility	324500000X	OK

General Provider Information

NPI Number	:	1093153942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVEN PHILLIPS

Provider Business Mailing Address
First Line	:	2621 N STERLING AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73127-1919
Country	:	US
Telephone Number	:	405-921-9724
Fax Number	:

Provider Business Practice Location Address
First Line	:	824 EAST DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73105-8418
Country	:	US
Telephone Number	:	405-557-1910
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2013
Last Update Date	:	06/12/2013

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