MEDICARE: SCPHILLIPS HEALTHCARE SOLUTIONS, LLC

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	247ZC0005X	Clinical Laboratory Director (Non-physician)

General Provider Information

NPI Number	:	1275280471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCPHILLIPS HEALTHCARE SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	4049 N BELT LINE RD APT 1011
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-8512
Country	:	US
Telephone Number	:	214-435-1678
Fax Number	:

Provider Business Practice Location Address
First Line	:	4049 N BELT LINE RD APT 1011
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-8512
Country	:	US
Telephone Number	:	214-435-1678
Fax Number	:

Authorized Official
Title or Position	:	LAB DIRECTOR
Name	:	SUSAN PHILLIPS
Credential	:	RN
Telephone Number	:	214-414-5456

Provider Enumeration Date	:	03/07/2022
Last Update Date	:	03/07/2022

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