Phillip M. McKean Professional Corporation

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PHILLIP M. MCKEAN PROFESSIONAL CORPORATION

Practice address

6605 E State Blvd Ste 7
Fort Wayne, IN 46815-7036

Phone

(260) 486-2339

Fax

(260) 486-3219

NPI assigned

Sep 6, 2019

Organization subpart

No

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

Authorized official

Name

Vickey Ray Hullinger

Title

Office Manager

Phone

(260) 486-2339

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Locations

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

{
    "created_epoch": "1567728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567728000000",
    "number": "1699324103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6605 E STATE BLVD STE 7",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468157036",
            "telephone_number": "260-486-2339",
            "fax_number": "260-486-3219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6605 E STATE BLVD STE 7",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468157036",
            "telephone_number": "260-486-2339",
            "fax_number": "260-486-3219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILLIP M. MCKEAN PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-06",
        "last_updated": "2019-09-06",
        "status": "A",
        "authorized_official_last_name": "HULLINGER",
        "authorized_official_first_name": "VICKEY",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "260-486-2339"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300028091",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "directexchange",
            "affiliation": "N",
            "address_1": "6605 E State Blvd Ste 7",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468157036",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "directexchange",
            "affiliation": "N",
            "address_1": "6605 E State Blvd Ste 7",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468157036",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• PHB Vision Group, P.C.
• Ryan Patrick Phelan, MD
• Tara Starr Phelps, M.A.,CCC-SLP
• Veronica A Philbin, RN, CNS
• Philip J Johnson MD Inc
• Stephen Richard Phillipp, MD
• Addison Danielle Phillippe
• Onna Phillippe, RBT
• Rene Michelle Phillippe, APRN, FNP-C,PMHNP-BC
• Milissa C. Phillips-Bohlender, NP

• General Practice Dentistry in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 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.