Basic Information
| Provider Information | |||||||||
| NPI: | 1427089234 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELLIS | ||||||||
| FirstName: | BLESILDA | ||||||||
| MiddleName: | Q | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7987 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366700987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516330573 | ||||||||
| FaxNumber: | 2516337367 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 SPRING HILL AVE | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514333344 | ||||||||
| FaxNumber: | 2514334052 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 06/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 27022 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RC0200X | 27022 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 168326 | 05 | AL | MEDICAID | 205842 | 05 | AL | MEDICAID | 7718053 | 01 | AL | CIGNA HC | OTHER | 512-05526 | 01 | AL | BCBS | OTHER | 5779364 | 01 | AL | AETNA | OTHER | P01438825 | 01 | AL | RR MEDICARE | OTHER | 00118449 | 01 | MS | MS MEDICAID | OTHER | 213438 | 05 | AL | MEDICAID | 511-95544 | 01 | AL | BCBS | OTHER | 102I293263 | 01 | AL | MEDICARE | OTHER | 1730048 | 01 | AL | UHC | OTHER | 211714 | 05 | AL | MEDICAID | F68986 | 01 | AL | VIVA HEALTH | OTHER | 203245 | 05 | AL | MEDICAID | 511-56774 | 01 | AL | BCBS | OTHER | 511-56775 | 01 | AL | BCBS | OTHER | 511-57064 | 01 | AL | BCBS | OTHER | 512-05528 | 01 | AL | BCBS | OTHER |