1912244419 NPI number — DEBRA R ELLIOTT PA-C

Table of content: DEBRA R ELLIOTT PA-C (NPI 1912244419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912244419 NPI number — DEBRA R ELLIOTT PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELLIOTT
Provider First Name:
DEBRA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ELLIOTT
Provider Other First Name:
DEBRA
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1912244419
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2520 BF TERRY BLVD.
Provider Second Line Business Mailing Address:
FM 2218
Provider Business Mailing Address City Name:
ROSENBERG
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-342-6006
Provider Business Mailing Address Fax Number:
281-239-7554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2520 BF TERRY BLVD.
Provider Second Line Business Practice Location Address:
FM 2218
Provider Business Practice Location Address City Name:
ROSENBERG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-342-6006
Provider Business Practice Location Address Fax Number:
281-239-7554
Provider Enumeration Date:
01/04/2013

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: 363A00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 320991801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8409NA . This is a "BC/BS #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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