Basic Information
| Provider Information | |||||||||
| NPI: | 1871595496 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PHILLIPS | ||||||||
| FirstName: | MATTHEW | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7800 SHOAL CREEK BLVD SUITE 205N | ||||||||
| Address2: | AUSTIN HEART, PLLC | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122064341 | ||||||||
| FaxNumber: | 5122064350 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 W CENTRAL TEXAS EXPY | ||||||||
| Address2: | STE. 355 | ||||||||
| City: | HARKER HEIGHTS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765481899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2545262085 | ||||||||
| FaxNumber: | 2545269569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2005 | ||||||||
| LastUpdateDate: | 04/03/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | K1897 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 1177164-03 | 05 | TX | MEDICAID | 1177164-04 | 05 | TX | MEDICAID |