1982869996 NPI number — DR. KATHERINE PHILLIPS DDS

Table of content: DR. KATHERINE PHILLIPS DDS (NPI 1982869996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982869996 NPI number — DR. KATHERINE PHILLIPS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILLIPS
Provider First Name:
KATHERINE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

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:
1982869996
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 GALLETA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77389-2404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-255-6111
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 MEDICAL PLAZA DR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THE WOODLANDS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77380-3257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-296-6797
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2008

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: 1223G0001X , with the licence number:  19027764 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 33213 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1508198474 . This is a "PRACTICE LOCATION TYPE II NPI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1063649770 . This is a "GROUP NPI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1295165439 . This is a "PRACTICE LOCATION TYPE II NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1760882005 . This is a "PRACTICE LOCATION TYPE II NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1053431981 . This is a "GROUP NPI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1205145554 . This is a "PRACTICE LOCATION TYPE II NPI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1306177241 . This is a "PRACTICE LOCATION TYPE II NPI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".