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NPI Code Detail

MEDICARE: DR. JOHN KENNETH PHILLIPS M.D.

MEDICARE: DR. JOHN KENNETH 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
12085R0202XDiagnostic Radiology PhysicianE0129AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518961580
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN KENNETH PHILLIPS M.D.
Provider Business Mailing Address
First Line : PO BOX 1960
Second Line : PO BOX 1960
City : JONESBORO
State : AR
Zip : 72403-1960
Country : US
Telephone Number : 870-936-8000
Fax Number : 870-936-1043
Provider Business Practice Location Address
First Line : 3024 STADIUM BLVD
Second Line :
City : JONESBORO
State : AR
Zip : 72401-7415
Country : US
Telephone Number : 870-934-5113
Fax Number : 870-392-3608
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2005
Last Update Date : 12/01/2016

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