Provider Demographics
NPI:1942304696
Name:ELLIS COUNTY MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:ELLIS COUNTY MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:JINKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-875-4700
Mailing Address - Street 1:802 W LAMPASAS ST
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-4536
Mailing Address - Country:US
Mailing Address - Phone:972-875-4700
Mailing Address - Fax:972-878-4527
Practice Address - Street 1:802 W LAMPASAS ST
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-4536
Practice Address - Country:US
Practice Address - Phone:972-875-4700
Practice Address - Fax:972-878-4527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX082028402Medicaid
TX00D41CMedicare UPIN