Active NPI
Phillip Hicks
- Anesthesiology Physician
- Clinton, MO
National Provider Identifier
1063563864
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 122530
- Practice address
- 1600 N 2ND St
Clinton, MO 64735-1192 - Phone
- (660) 890-7103
- NPI assigned
- Jan 16, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 122530 | MO | Primary |
Addresses
Primary practice location
1600 N 2ND St
Clinton, MO 64735-1192
Mailing address
2003 Epicurean Dr
Clinton, MO 64735-1887
Phone (660) 890-7103
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 915043905 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 122530 | MO | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282089600000",
"number": "1063563864",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2003 EPICUREAN DR",
"city": "CLINTON",
"state": "MO",
"postal_code": "647351887",
"telephone_number": "660-890-7103",
"fax_number": "660-885-8496"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 N 2ND ST",
"city": "CLINTON",
"state": "MO",
"postal_code": "647351192",
"telephone_number": "660-890-7103"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKS",
"first_name": "PHILLIP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-16",
"last_updated": "2010-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "MO",
"license": "122530",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "915043905",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clinton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.