MEDICARE: TRACY THOMAS PHILLIPS D.O.

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	261QP2300X	Primary Care Clinic/Center	E1018	AR
2	208M00000X	Hospitalist Physician	E-1018	AR
3	207Q00000X	Family Medicine Physician	E1018	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	2Z0853	OTHER	AR	MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1679571863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY THOMAS PHILLIPS D.O.

Provider Business Mailing Address
First Line	:	PO BOX 13554
Second Line	:
City	:	MAUMELLE
State	:	AR
Zip	:	72113-0554
Country	:	US
Telephone Number	:	501-350-8505
Fax Number	:	501-488-1020

Provider Business Practice Location Address
First Line	:	2001 CLUB MANOR DR STE S
Second Line	:
City	:	MAUMELLE
State	:	AR
Zip	:	72113-7417
Country	:	US
Telephone Number	:	501-734-8085
Fax Number	:	501-734-8088

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	05/29/2024

Similar Medicare Providers

1720007958 — LEE ANN DUNLAP LCSW
Practice Location Address:

2001 CLUB MANOR DR STE J
MAUMELLE, AR
72113-7417

Practice Phone: 501-687-0488
Practice Fax: 501-687-0489

1003835257 — HAAS PSYCHIATRIC SERVICES, P.A.
Practice Location Address:

2001 CLUB MANOR DR STE J
MAUMELLE, AR
72113-7417

Practice Phone: 501-687-0488
Practice Fax: 501-687-0489

1184646432 — MATTHEW RICHARD FREDERICK LCSW
Practice Location Address:

2001 CLUB MANOR DR STE J
MAUMELLE, AR
72113-7417

Practice Phone: 501-687-0488
Practice Fax: 501-687-0489

1902133663 — MISS PEARL AMBER TURNEY OTRL
Practice Location Address:

2001 CLUB MANOR DR STE G
MAUMELLE, AR
72113-7417

Practice Phone: 866-251-1227
Practice Fax: 866-251-1267

1124482971 — HAAS PSYCHIATRIC SERVICES, PA
Practice Location Address:

2001 CLUB MANOR DR STE J
MAUMELLE, AR
72113-7417

Practice Phone: 501-687-0488
Practice Fax: 501-687-0489

1700431723 — TIFFANY LACK APRN, FNP-BC
Practice Location Address:

2001 CLUB MANOR DR STE S
MAUMELLE, AR
72113-7417

Practice Phone: 501-734-8085
Practice Fax: 501-734-8085

Directions to “ TRACY THOMAS PHILLIPS D.O.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.