Basic Information
| Provider Information | |||||||||
| NPI: | 1306823927 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHILLIPS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7100 OAKMONT BLVD STE 205 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761323908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174684343 | ||||||||
| FaxNumber: | 8174683438 | ||||||||
| Practice Location | |||||||||
| Address1: | 829 N NOLAN RIVER RD | ||||||||
| Address2: | |||||||||
| City: | CLEBURNE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760337085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175584600 | ||||||||
| FaxNumber: | 8174683438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2005 | ||||||||
| LastUpdateDate: | 01/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | K2983 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | K2983 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 208VP0014X | K2983 | TX | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 136902714 | 01 | TX | MEDICAID-00606K | OTHER | 8G7059 | 01 | TX | BCBS | OTHER | P00160206 | 01 | TX | RAILROAD | OTHER | 136902717 | 05 | TX | MEDICAID | 136902716 | 01 | TX | MEDICAID-00607K | OTHER | 8C0801 | 01 | TX | MEDICARE-00339K | OTHER | 8K7832 | 01 | TX | MEDICARE-00607K | OTHER | 136902713 | 01 | TX | MEDICAID-00339K | OTHER | 8D2510 | 01 | TX | MEDICARE-00606K | OTHER |