1427089234 NPI number — DR. BLESILDA Q ELLIS M.D.

Table of content: DR. BLESILDA Q ELLIS M.D. (NPI 1427089234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427089234 NPI number — DR. BLESILDA Q ELLIS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELLIS
Provider First Name:
BLESILDA
Provider Middle Name:
Q
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427089234
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7987
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36670-0987
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-633-0573
Provider Business Mailing Address Fax Number:
251-633-7367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1415 TULANE AVE FL 7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70112-2600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-988-8600
Provider Business Practice Location Address Fax Number:
504-988-8688
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , with the licence number:  27022 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 27022 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: MD.09330R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00118449 . This is a "MS MEDICAID" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 168326 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1972581 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 512-05526 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 211714 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 213438 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5779364 . This is a "AETNA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 205842 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 511-56775 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 511-56774 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 511-95544 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 512-05528 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: F68986 . This is a "VIVA HEALTH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 102I293263 . This is a "MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 511-57064 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: P01438825 . This is a "RR MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1730048 . This is a "UHC" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 203245 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7718053 . This is a "CIGNA HC" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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