Provider Demographics
NPI:1164967824
Name:JOHN C MCELROY MD PA
Entity Type:Organization
Organization Name:JOHN C MCELROY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCELROY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-420-1776
Mailing Address - Street 1:5000 LONG PRAIRIE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2783
Mailing Address - Country:US
Mailing Address - Phone:972-420-1776
Mailing Address - Fax:972-221-8685
Practice Address - Street 1:1234 FM 407
Practice Address - Street 2:STE 100
Practice Address - City:NORTH LAKE
Practice Address - State:TX
Practice Address - Zip Code:76226
Practice Address - Country:US
Practice Address - Phone:972-420-1776
Practice Address - Fax:972-221-8685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ4202207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX576623OtherMEDICARE
7624920002OtherMEDICARE NSC