JERI L ELLIS MD MPH PC NPI 1538672001

NPI Information

NPI: 1538672001
Provider Name: JERI L ELLIS MD, MPH, PC

Doing Business As: ELLIS FAMILY PRACTICE

Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
420 N KICKAPOO AVE
SHAWNEE, OK
ZIP 74801
Phone: (400) 581-6331
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JERI L ELLIS MD, MPH, PC is a primary care clinic center in Shawnee, OK. JERI L ELLIS MD, MPH, PC NPI is 1538672001. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Ellis Family Practice.

The provider's business location address is:

420 N KICKAPOO AVE
SHAWNEE, OK
ZIP 74801-643
Phone: (400) 581-6331

The provider's authorized official is Denise Cato .
The authorized official title is Contracting Manager and has the following contact phone number (405) 470-1884.

The enumeration date for this NPI number is 11/7/2017 and was last updated on 11/7/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207QA0505X	Family Medicine	Adult Medicine			No
2	261QP2300X	Clinic/Center	Primary Care			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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