DR. RANDALL E ELLIS (NPI# 1396784138) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396784138 |
| Entity Type | Individual |
| Full Name | DR. RANDALL E ELLIS |
| Credential | M.D. |
| Practice Address |
2320 Wilma Rudolph Blvd Clarksville TN 37040-5821 |
| Practice Telephone | 9316451564 |
| Practice Fax Number | 9316453842 |
| Mailing Telephone | 9316451564 |
| Mailing Fax Number | 9316453842 |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | MD27444 | TN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | BLUECROSS BLUESHIELD | 4041098 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740328046 | Randall A. Ellis | Dentist | 312 Arkansas Blvd, Texarkana, AR 71854-1905 | 2007-02-01 |
| 1427026095 | Randall William Ellis | Dentist | 2859 E Fountain Blvd, Colorado Springs, CO 80910-2312 | 2006-03-09 |
| 1073901971 | Randall W Ellis | Registered Nurse | 2 Keewaydin Dr, Salem, NH 03079-2839 | 2014-12-30 |
| Street Address |
2320 WILMA RUDOLPH BLVD |
| City | CLARKSVILLE |
| State | TN |
| Zip Code | 37040-5821 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043285539 | Clarksville Imaging Center LLC | Specialist | 2320 Wilma Rudolph Blvd, Clarksville, TN 37040-5821 | 2006-02-20 |
| 1851538177 | Truman Adolf Gartman IIi | Physician Assistant | 2320 Wilma Rudolph Blvd, Clarksville, TN 37040-8960 | 2009-01-08 |
| 1427115260 | Louis D Couly | Physician Assistant | 2320 Wilma Rudolph Blvd, Clarksville, TN 37040-8960 | 2007-01-02 |
| 1548346166 | Jacqueline R Marco | Physician Assistant | 2320 Wilma Rudolph Blvd, Clarksville, TN 37040-5821 | 2006-10-27 |
| 1265471932 | Timothy L Obernuefemann | Emergency Medicine | 2320 Wilma Rudolph Blvd, Clarksville, TN 37040-5821 | 2006-06-06 |
| 1598704355 | William D Shippen Jr. | Emergency Medicine | 2320 Wilma Rudolph Blvd, Clarksville, TN 37040-5821 | 2006-06-06 |
| 1649226606 | Ambulatory and Occupational Health Clinic PC | Clinic/Center | 2320 Wilma Rudolph Blvd, Clarksville, TN 37040-5821 | 2006-05-25 |
| 1346295425 | Stephen Warren Kent | Emergency Medicine | 2320 Wilma Rudolph Blvd, Clarksville, TN 37040-5821 | 2006-05-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770124380 | Clarksville Treatment Center, LLC | Clinic/Center | 495 Dunlop Lane, Clarksville, TN 37040 | 2019-10-04 |
| 1295384956 | Dena Marie Borchick | Technician | 3779 Cindy Jo Dr. N, Clarksville, TN 37040 | 2019-09-05 |
| 1477014488 | Emily Allen | Dentist | 930 Hwy 76, Clarksville, TN 37040 | 2019-03-31 |
| 1730640566 | Latoya Ewert | Counselor | Centerstone Clarksville Harriet Cohn Center, 511 8th Street, Clarksville, TN 37040 | 2019-03-26 |
| 1356811988 | Jamie Coles | Behavior Technician | 851 Professional Park Drive 851 Profesiional Park Drive, Clarksville, TN 37040 | 2018-11-27 |
| 1518448554 | Bandel Counseling Service | Clinic/Center | 113 3rd St., Suite 25, Clarksville, TN 37040 | 2018-08-28 |
| 1477052520 | Bridget Stokes | Behavior Technician | 2277 Wilma Rudolph Blvd., Suite C #259, Clarksville, TN 37040 | 2018-02-05 |
| 1053824334 | Sandra Loren Coates | Nurse Practitioner | 980 Professional Park Dr Ste C, Clarksville, TN 37040 | 2017-11-09 |
| 1902328362 | Terri Brooke Roach | Registered Nurse | 651 Dunlop Lane, Clarksville, TN 37040 | 2017-07-07 |
| 1093244428 | Nikkia Deneil Bell | Behavior Technician | 139 E. Old Trenton Rd, Suite B, Clarksville, TN 37040 | 2017-06-08 |
| Find all providers in zip 37040 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578728002 | Simon Martin Spilkin | Emergency Medicine | 1492 Tiny Town Rd, Suite A1&a2, Clarksville, TN 37042-7873 | 2008-07-24 |
| 1144417528 | Ameet Sharad Parikh | Emergency Medicine | 12313 Daniel Circle Ln, Clarksville, MD 21029-1197 | 2007-09-28 |
| 1003993213 | Kaiser Ahmad, Pa | Emergency Medicine | 6404 Western Star Run, Clarksville, MD 21029-1247 | 2006-11-01 |
| 1760599575 | Syed Ahmed Naseeruddin | Emergency Medicine | 137 Village Way, Clarksville, TN 37043-5458 | 2006-08-25 |
| 1346277324 | Jackie L Hinds | Emergency Medicine | 651 Dunlop Ln., Gateway Med Center, Clarksville, TN 37040-5015 | 2006-06-27 |
| 1841239647 | Gregory Laurent Conner | Emergency Medicine | 2191 Memorial Dr, Aptartment G95, Clarksville, TN 37043-4797 | 2006-06-06 |
| 1174570014 | Mark A Muiznieks | Emergency Medicine | 651 Dunlop Lane Clarksville, Clarksville, TN 37040-5015 | 2006-05-27 |
| 1568446268 | Henry Shipley Hewes | Emergency Medicine | 720 County Road 3100, Clarksville, TX 75426-6612 | 2005-12-06 |
| 1194259630 | Logan Snyder I | Emergency Medicine | 651 Dunlop Ln, Clarksville, TN 37040-5015 | 2017-04-11 |
| 1609259753 | East Arkansas Emergency Physicians, Pllc | Emergency Medicine | 1100 E Poplar St, Clarksville, AR 72830-4419 | 2015-07-08 |
| Find all providers in CLARKSVILLE | ||||
| City | CLARKSVILLE |
| Zip Code | 37040 |
Please comment or provide details below to improve the information on DR. RANDALL E ELLIS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.