PHILLIPS FAMILY HEALTHCARE, LLC NPI 1629457254

Nurse Practitioner (Family) in Marion, AR

NPI 1629457254 Organization Nurse Practitioner Family CLIA Number 04D2097681 CLIA Certificate of Waiver

About PHILLIPS FAMILY HEALTHCARE, LLC

Phillips Family Healthcare, Llc is a provider established in Marion, Arkansas specializing in nurse practitioner (family) . The NPI number of Phillips Family Healthcare, Llc is 1629457254 and was assigned on May 2015. The practitioner's primary taxonomy code is 363LF0000X with license number A003572 (AR). The provider is registered as an organization and their NPI record was last updated 7 years ago. Phillips Family Healthcare, Llc operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The authorized official of this NPI record is Ted Phillips Aprn (Owner/practitioner)

A nurse practitioner (NP) like Phillips Family Healthcare, Llc is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, etc.

The CLIA number of Phillips Family Healthcare, Llc is 04D2097681 registered as a "other practitioner" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Phillips Family Healthcare, Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI

1629457254

Provider NamePHILLIPS FAMILY HEALTHCARE, LLC
Provider Location Address2921 HWY 77 S SUITES 12-13 MARION, AR 72364
Provider Mailing Address2921 HWY 77 S SUITES 12-13 MARION, AR 72364
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date05-28-2015
Last Update Date05-28-2015


Primary Taxonomy

Taxonomy Code363LF0000X
ClassificationNurse Practitioner
TypePhysician Assistants & Advanced Practice Nursing Providers
SpecializationFamily
License No.A003572
License StateAR

Business Address

PHILLIPS FAMILY HEALTHCARE, LLC
2921 HWY 77 S
SUITES 12-13
MARION, AR
ZIP 72364
Phone: (901) 438-8451

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Mailing Address

PHILLIPS FAMILY HEALTHCARE, LLC
2921 HWY 77 S
SUITES 12-13
MARION, AR
ZIP 72364
Phone: (901) 438-8451



Authorized Official

Authorized Official Name TED PHILLIPS APRN
Authorized Official TitleOWNER/PRACTITIONER
Authorized Official Phone(901) 438-8451

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1629457254 is:

CLIA Number04D2097681
Facility TypeOTHER PRACTITIONER
Certificate TypeCertificate of Waiver

Group Taxonomy


193400000X SINGLE SPECIALTY GROUP - This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
1043527336MEDICAID (05)AR
1043527336MEDICARE NSC (07)
1043527336OTHER (01)

Other Providers at the same location


The following 2 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1275549172 GLORIA L GRAHAM NP
Individual
Nurse Practitioner2921 HWY 77 S SUITE 20
MARION, AR 72364
(870) 739-5311
1154719508HEART2HEART COUNSELING ASSOCIATES LLC
Organization
Social Worker (Clinical)2921 HWY 77 S SUITES 20
MARION, AR 72364
(502) 224-2441

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.