MEDICARE: MRS. ANNE 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	174400000X	Specialist	MT043823	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CDE845084817	OTHER	TX	BLUECROSS BLUESHIELD

General Provider Information

NPI Number	:	1497990030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNE PHILLIPS

Provider Business Mailing Address
First Line	:	815 PLANTATION DR
Second Line	:	SUITE 160
City	:	RICHMOND
State	:	TX
Zip	:	77406-5038
Country	:	US
Telephone Number	:	832-595-6001
Fax Number	:	832-595-6003

Provider Business Practice Location Address
First Line	:	815 PLANTATION DR
Second Line	:	SUITE 160
City	:	RICHMOND
State	:	TX
Zip	:	77406-5038
Country	:	US
Telephone Number	:	832-595-6001
Fax Number	:	832-595-6003

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

Provider Enumeration Date	:	12/11/2008
Last Update Date	:	12/11/2008

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Directions to “ MRS. ANNE PHILLIPS ” Practice Location

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