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NPI Code Detail

MEDICARE: DR. MICHAEL SHANE PHILLIPS M.D.

MEDICARE: DR. MICHAEL SHANE PHILLIPS M.D.
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
1207Q00000XFamily Medicine Physician14837RLA

General Provider Information

NPI Number : 1154391431
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL SHANE PHILLIPS M.D.
Provider Business Mailing Address
First Line : PO BOX 829
Second Line :
City : RUSTON
State : LA
Zip : 71273-0829
Country : US
Telephone Number : 318-399-7130
Fax Number : 318-399-7139
Provider Business Practice Location Address
First Line : 1809 NORTHPOINTE LN STE 102
Second Line :
City : RUSTON
State : LA
Zip : 71270-3852
Country : US
Telephone Number : 318-399-7130
Fax Number : 318-399-7139
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2006
Last Update Date : 05/29/2026

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