1558466169 NPI number — DR. JAMMIE D PHILLIPS D. C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558466169 NPI number — DR. JAMMIE D PHILLIPS D. C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILLIPS
Provider First Name:
JAMMIE
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D. C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558466169
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 512
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NESS CITY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67560-0512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-798-3915
Provider Business Mailing Address Fax Number:
785-798-3916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2601 CENTRAL AVE
Provider Second Line Business Practice Location Address:
VILLAGE SQUARE MALL
Provider Business Practice Location Address City Name:
DODGE CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67801-6200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-225-4139
Provider Business Practice Location Address Fax Number:
620-225-4286
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  KS 4908 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: KS4908 . This is a "KANSAS LICENSE NO" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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