Provider Demographics
NPI:1134318215
Name:ELLIOTT-THOMAS HEALTH CENTER PC
Entity Type:Organization
Organization Name:ELLIOTT-THOMAS HEALTH CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-569-2006
Mailing Address - Street 1:415 W KILPATRICK ST
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:TX
Mailing Address - Zip Code:75773-2032
Mailing Address - Country:US
Mailing Address - Phone:903-569-2006
Mailing Address - Fax:903-569-2206
Practice Address - Street 1:415 W KILPATRICK ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:TX
Practice Address - Zip Code:75773-2032
Practice Address - Country:US
Practice Address - Phone:903-569-2006
Practice Address - Fax:903-569-2206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1568207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165700901Medicaid
TXB74324OtherUPIN
TX00609UOtherMEDICARE PTAN
TX8H0920OtherBCBS
TX110247094OtherRAILROAD MEDICARE