Provider Demographics
NPI:1053192401
Name:PHILLIPS CLINIC COMPANY, LLC
Entity type:Organization
Organization Name:PHILLIPS CLINIC COMPANY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR DIRECTOR PHYSICIAN PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-221-3641
Mailing Address - Street 1:265 NORTH LAMAR BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-3710
Mailing Address - Country:US
Mailing Address - Phone:870-338-5800
Mailing Address - Fax:
Practice Address - Street 1:1803 MARTIN LUTHER KING JR DR STE A
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AR
Practice Address - Zip Code:72342-9103
Practice Address - Country:US
Practice Address - Phone:870-338-7441
Practice Address - Fax:870-338-7945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health