Provider Demographics
NPI:1154328250
Name:KNOX, ELLEN PORTER (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:PORTER
Last Name:KNOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ZORN AVE
Mailing Address - Street 2:ROBLEY REX VAMC
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206
Mailing Address - Country:US
Mailing Address - Phone:502-287-4000
Mailing Address - Fax:502-287-6892
Practice Address - Street 1:800 ZORN AVE
Practice Address - Street 2:ROBLEY REX VAMC
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206
Practice Address - Country:US
Practice Address - Phone:502-287-4000
Practice Address - Fax:502-287-6892
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039537A2084P0800X
KY266562084P0800X
IN010395372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64266562Medicaid
INP00204278OtherRAILROAD MEDICARE
KYP00639807OtherRAILROAD MEDICARE
IN100362960AMedicaid
KY2703588000OtherPASSPORT ADVANTAGE
000000344393OtherANTHEM ID #
KY2444451000OtherPASSPORT ADVANTAGE GROUP
KY6764OtherMEDICARE GROUP
IN160860OtherMEDICARE GROUP
41051000OtherMAGELLAN MIS
KY65927857OtherMEDICAID GROUP
KY78903689OtherMEDICAID GROUP
KY82900176OtherMEDICAID GROUP
INCG3623OtherRAILROAD MEDICARE GROUP
000000056294OtherANTHEM GROUP
IN100386460OtherMEDICAID GROUP
KYCK2274OtherRAILROAD MEDICARE GROUP
IN160780OtherMEDICARE GROUP
50704000OtherMAGELLAN GROUP
1063415297OtherGROUP NPI
E07379Medicare UPIN
KY676466Medicare PIN
IN160860OtherMEDICARE GROUP
KY64266562Medicaid