Provider Demographics
NPI:1730218520
Name:J. SCOTT ELLIS, DO, PA
Entity type:Organization
Organization Name:J. SCOTT ELLIS, DO, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:806-665-9900
Mailing Address - Street 1:3023 PERRYTON PKWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-2821
Mailing Address - Country:US
Mailing Address - Phone:806-665-9900
Mailing Address - Fax:806-665-9905
Practice Address - Street 1:3023 PERRYTON PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-2821
Practice Address - Country:US
Practice Address - Phone:806-665-9900
Practice Address - Fax:806-665-9905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6229207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0042KDOtherBLUE CROSS
TX00374VMedicare ID - Type Unspecified