MEDICARE: CARSON 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	207Q00000X	Family Medicine Physician	10533	SD

General Provider Information

NPI Number	:	1518372127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARSON PHILLIPS

Provider Business Mailing Address
First Line	:	2822 JACKSON BLVD STE 101
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-3497
Country	:	US
Telephone Number	:	605-341-1208
Fax Number	:	605-341-3552

Provider Business Practice Location Address
First Line	:	2822 JACKSON BLVD STE 101
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-3497
Country	:	US
Telephone Number	:	605-341-1208
Fax Number	:	605-341-3552

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

Provider Enumeration Date	:	06/23/2014
Last Update Date	:	11/02/2017

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Directions to “ CARSON PHILLIPS ” Practice Location

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