Provider Demographics
NPI:1538486246
Name:MDASSISTLLC
Entity Type:Organization
Organization Name:MDASSISTLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-937-7240
Mailing Address - Street 1:1626 W HIGHWAY 287 BUSINESS
Mailing Address - Street 2:107
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-4712
Mailing Address - Country:US
Mailing Address - Phone:972-937-7240
Mailing Address - Fax:972-937-4255
Practice Address - Street 1:1626 W HIGHWAY 287 BUSINESS
Practice Address - Street 2:107
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-4712
Practice Address - Country:US
Practice Address - Phone:972-937-7240
Practice Address - Fax:972-937-4255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist AssistantGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C8825Medicare PIN