Basic Information
| Provider Information | |||||||||
| NPI: | 1184634628 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PHILLIPS | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | EUGENE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5655 HUDSON DR STE 210 | ||||||||
| Address2: | ARIS RADIOLOGY | ||||||||
| City: | HUDSON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442364455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306551869 | ||||||||
| FaxNumber: | 3306553828 | ||||||||
| Practice Location | |||||||||
| Address1: | 1241 WOODLAND AVENUE | ||||||||
| Address2: | |||||||||
| City: | MOUNT PLEASANT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438240606 | ||||||||
| FaxNumber: | 8438240909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 10/26/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | ME19472 | SC | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085N0904X | ME19472 | SC | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085P0229X | ME19472 | SC | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0202X | ME19472 | SC | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | ME19472 | SC | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085U0001X | ME19472 | SC | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound |
ID Information
| ID | Type | State | Issuer | Description | 300109662 | 01 | MEDICARE RR | OTHER | 8683 | 01 | SC | MEDICARE GROUP | OTHER | 1709 | 01 | SC | MEDICARE GROUP | OTHER | 194729 | 05 | SC | MEDICAID |