Provider Demographics
NPI:1780860387
Name:SHELLEY C. FERRILL, M.D.PA
Entity Type:Organization
Organization Name:SHELLEY C. FERRILL, M.D.PA
Other - Org Name:DBA FAMILY MEDICAL CENTER AT CINCO RANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-392-5005
Mailing Address - Street 1:23144 WESTHEIMER PKWY
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3603
Mailing Address - Country:US
Mailing Address - Phone:281-392-5005
Mailing Address - Fax:281-395-5052
Practice Address - Street 1:23144 WESTHEIMER PKWY
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-3603
Practice Address - Country:US
Practice Address - Phone:281-392-5005
Practice Address - Fax:281-395-5052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2247207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH00414Medicare UPIN