Organization
GREENVILLE EAR NOSE & THROAT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN GORDON PHILLIPS M.D. (DR. JOHN GORDON PHILLIPS)
(864) 454-4368
Entity
Organization
Contact information
Practice address
200 PATEWOOD DR, BUILDING B SUITE B400, GREENVILLE, SC 29615-3593
(864) 454-4368
(864) 454-4345
Mailing address
PO BOX 26569, GREENVILLE, SC 29616-1569
(864) 454-4368
(864) 454-4345
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
15939
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CL5602
RAILROAD MEDICARE
SC
05
—
GP0618
—
SC
Enumeration date
03/23/2006
Last updated
12/04/2007
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