Basic Information
| Provider Information | |||||||||
| NPI: | 1891103503 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KATHERINE ELLIS MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1302 N STATE HIGHWAY 91 | ||||||||
| Address2: | |||||||||
| City: | DENISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750201167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034651581 | ||||||||
| FaxNumber: | 9033278023 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 REBA MACENTIRE LN | ||||||||
| Address2: | |||||||||
| City: | DENISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750209057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034651857 | ||||||||
| FaxNumber: | 9033278023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2014 | ||||||||
| LastUpdateDate: | 01/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | BARRETT | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9034651857 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | J3091 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.