| Phillips Family Medicine Clinic Llc | |
|
2 Medical Plaza Pl Minden LA 71055-3330 | |
| (318) 382-9401 | |
| (318) 382-9403 |
| Full Name | Phillips Family Medicine Clinic Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2 Medical Plaza Pl, Minden, Louisiana |
| Authorized Official Name and Position | Gregory Scott Phillips (OWNER) |
| Authorized Official Contact | 3183829401 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phillips Family Medicine Clinic Llc 2 Medical Plaza Pl Minden LA 71055-3330 Ph: (318) 382-9401 | Phillips Family Medicine Clinic Llc 2 Medical Plaza Pl Minden LA 71055-3330 Ph: (318) 382-9401 |
| NPI Number | 1306396007 |
|---|---|
| Provider Enumeration Date | 10/06/2016 |
| Last Update Date | 05/08/2024 |
| Medicare PECOS PAC ID | 5799065678 |
|---|---|
| Medicare Enrollment ID | O20161212000962 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306396007 | NPI | - | NPPES |
| 1495344 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 023191 (Louisiana) | Primary |
| Provider Name | Gregory S Phillips |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497743413 PECOS PAC ID: 6800705443 Enrollment ID: I20041201000619 |
| Provider Name | Lillian Leigh B Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306092937 PECOS PAC ID: 3173662889 Enrollment ID: I20091209000041 |
| Provider Name | G.michelle Gray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184884546 PECOS PAC ID: 8123279544 Enrollment ID: I20121113000233 |
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