Phoenix Provider Services

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

License

017609 Issued in TX

Legal business name

PHOENIX PROVIDER SERVICES

Practice address

113 N Stagecoach Rd
Salado, TX 76571-6109

Phone

(254) 220-3322

NPI assigned

Jan 23, 2017

Last updated

Jan 28, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jamie Burgess

Title

Administrator/Owner

Phone

(254) 220-3322

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1485129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548633600000",
    "number": "1659818185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6213 SUELLEN LN",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765425479",
            "telephone_number": "254-220-3322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 N STAGECOACH RD",
            "city": "SALADO",
            "state": "TX",
            "postal_code": "765716109",
            "telephone_number": "254-220-3322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX PROVIDER SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-23",
        "last_updated": "2019-01-28",
        "status": "A",
        "authorized_official_last_name": "BURGESS",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_title_or_position": "ADMINISTRATOR/OWNER",
        "authorized_official_telephone_number": "254-220-3322"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "TX",
            "license": "017609",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.