Provider Demographics
NPI:1073698585
Name:FERRELL ROPER CLINIC, PLLC
Entity Type:Organization
Organization Name:FERRELL ROPER CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:GAIDO
Authorized Official - Last Name:ROPER
Authorized Official - Suffix:
Authorized Official - Credentials:RN FNP
Authorized Official - Phone:903-894-7206
Mailing Address - Street 1:PO BOX 195
Mailing Address - Street 2:
Mailing Address - City:BULLARD
Mailing Address - State:TX
Mailing Address - Zip Code:75757-0195
Mailing Address - Country:US
Mailing Address - Phone:903-894-7206
Mailing Address - Fax:903-894-6119
Practice Address - Street 1:105 NORTH PHILLIPS STREET
Practice Address - Street 2:
Practice Address - City:BULLARD
Practice Address - State:TX
Practice Address - Zip Code:75757
Practice Address - Country:US
Practice Address - Phone:903-894-7206
Practice Address - Fax:903-894-6119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX226114363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ41462OtherRAILROAD MEDICARE
TX00X448Medicare PIN