Provider Demographics
NPI:1184838526
Name:ELLIS COUNTY SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:ELLIS COUNTY SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YOMI
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FAYIGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-923-2600
Mailing Address - Street 1:1626 W HIGHWAY 287 BUSINESS
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-4712
Mailing Address - Country:US
Mailing Address - Phone:972-923-2600
Mailing Address - Fax:972-923-1013
Practice Address - Street 1:1626 W HIGHWAY 287 BUSINESS
Practice Address - Street 2:SUITE 102
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-4712
Practice Address - Country:US
Practice Address - Phone:972-923-2600
Practice Address - Fax:972-923-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9921208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128623901Medicaid
TXE41913Medicare UPIN
TX00U40NMedicare PIN