Basic Information
| Provider Information | |||||||||
| NPI: | 1538352604 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHILLIPS | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | ARTHUR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1267 | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242831267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767380000 | ||||||||
| FaxNumber: | 2768895505 | ||||||||
| Practice Location | |||||||||
| Address1: | 58 CARROLL STREET | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2768838000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2007 | ||||||||
| LastUpdateDate: | 06/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | DO1988 | TN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 1988 | TN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 0102202256 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 1988 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 0102202256 | VA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3714470 | 01 | TN | GROUP MEDICARE | OTHER | 621052914073 | 01 | TN | TRICARE | OTHER | 1538352604 | 05 | VA | MEDICAID |