Provider Demographics
NPI:1790932259
Name:ELLIS PEDIATRICS
Entity Type:Organization
Organization Name:ELLIS PEDIATRICS
Other - Org Name:NORTH AUSTIN PEDIATRICS, P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEIGHTON
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-491-5125
Mailing Address - Street 1:12201 RENFERT WAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5354
Mailing Address - Country:US
Mailing Address - Phone:512-491-5125
Mailing Address - Fax:512-491-8521
Practice Address - Street 1:12201 RENFERT WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5354
Practice Address - Country:US
Practice Address - Phone:512-491-5125
Practice Address - Fax:512-491-8521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2457208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty