Provider Demographics
NPI:1891348959
Name:DAVID P ELLENT PLLC
Entity Type:Organization
Organization Name:DAVID P ELLENT PLLC
Other - Org Name:GENESIS MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TARASENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-908-0686
Mailing Address - Street 1:22001 NORTHPARK DR STE 220
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3811
Mailing Address - Country:US
Mailing Address - Phone:281-908-0686
Mailing Address - Fax:
Practice Address - Street 1:22001 NORTHPARK DR STE 220
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3810
Practice Address - Country:US
Practice Address - Phone:281-319-8399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-18
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory