Provider Demographics
NPI:1740417831
Name:JOE ELLIS WHEELER
Entity Type:Organization
Organization Name:JOE ELLIS WHEELER
Other - Org Name:JOE ELLIS WHEELER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING/COLLECIONS SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:FRENZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-335-3966
Mailing Address - Street 1:1650 W ROSEDALE ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7400
Mailing Address - Country:US
Mailing Address - Phone:817-335-3966
Mailing Address - Fax:817-335-7926
Practice Address - Street 1:1650 W ROSEDALE ST
Practice Address - Street 2:SUITE 305
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7400
Practice Address - Country:US
Practice Address - Phone:817-335-3966
Practice Address - Fax:817-335-7926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD1855174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1154007-01Medicaid
TX00NO6EMedicare PIN
TX1154007-01Medicaid