MR. EDWIN F ELLIS (NPI# 1467443309) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467443309 |
| Entity Type | Individual |
| Full Name | MR. EDWIN F ELLIS |
| Credential | M.D. |
| Practice Address |
1020 N Lawson Boulevard Clayton OK 74536-0219 |
| Mailing Address |
Po Box 219 Clayton OK 74536-0219 |
| Practice Telephone | 9185694143 |
| Practice Fax Number | 9185697552 |
| Mailing Telephone | 9185694143 |
| Mailing Fax Number | 9185697343 |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2015-01-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | 8832 | OK | Allopathic & Osteopathic Physicians |
| Y | 208D00000X | General Practice | 8832 | OK | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 200072150B | 05 |
| Street Address |
1020 N LAWSON BOULEVARD |
| City | CLAYTON |
| State | OK |
| Zip Code | 74536-0219 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730490715 | Gerald N Harper | Nurse Practitioner | 1020 N Lawson Boulevard, Clayton, OK 74536-0219 | 2010-06-24 |
| 1922077049 | Bambi A Clay | Physician Assistant | 1020 N Lawson Boulevard, Clayton, OK 74536-0219 | 2006-03-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609350057 | Cody Blaine Powell | Chiropractor | 1020 Lawson Blvd, Clayton, OK 74536 | 2018-09-21 |
| 1598167421 | Aimee Nicole Freeman | Social Worker | 1020 N Lawson Blvd., Clayton, OK 74536 | 2014-09-23 |
| 1518268762 | Curatio Hospice Inc | Exclusive Provider Organization | 617 North Lawson Street, Clayton, OK 74536 | 2010-11-04 |
| 1326286717 | Town of Clayton | Ambulance | 221 W. Cherokee Street, Clayton, OK 74536 | 2009-01-23 |
| 1417043696 | Ernest B Perkins | Physician Assistant | 109 Stanley Road, Clayton, OK 74536 | 2006-10-05 |
| 1073525002 | Best Life Rx, LLC | Durable Medical Equipment & Medical Supplies | 536 N Lawson Blvd, Clayton, OK 74536 | 2006-08-11 |
| 1619941242 | Bob H Womack | Dentist | 109 Stanly Rd, Clayton, OK 74536 | 2006-02-13 |
| 1669021580 | Christopher Lynn Smith | Nurse Practitioner | 1020 Lawson Blvd, Clayton, OK 74536 | 2019-09-04 |
| 1891882676 | Pushmataha Family Medical Center, Inc | Clinic/Center | 109 Stanley Road, Clayton, OK 74536 | 2006-10-05 |
| 1275737314 | Clayton Public School | Counselor | 101 Pine Street, Clayton, OK 74536-0190 | 2007-06-13 |
| Find all providers in zip 74536 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
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| 1285677492 | Carl Louis Schopfer | General Practice | 115 S Delsea Dr, Clayton, NJ 08312-1913 | 2006-06-14 |
| 1013919034 | Mark Edward Van Wormer | General Practice | 314 N 3rd Ave, Clayton, NM 88415-3302 | 2005-08-10 |
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| 1366687774 | Robin Lee Line | General Practice | 773 N Main St, Clayton, GA 30525-4257 | 2008-12-15 |
| 1629141296 | Cameron Luther Perkins | General Practice | 11491 Us Highway 70 W, Clayton, NC 27520-2207 | 2006-11-15 |
| 1104912096 | Clayton Urgent Care and Family Clinic Pa | General Practice | 11491 Us Highway 70 W, Clayton, NC 27520 | 2006-10-05 |
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| 1902396294 | Gail Renee Marchant | General Practice | 8784 E 105th Ct, Tulsa, OK 74133-7063 | 2018-05-13 |
| 1528578499 | Revive Medical LLC | General Practice | 4215 N Classen Blvd Ste 103, Oklahoma City, OK 73118 | 2017-10-05 |
| 1992214548 | Lifestyle Medical Center, Pllc | General Practice | 4505 S Harvard Ave, Tulsa, OK 74135-2905 | 2017-09-27 |
| 1265884449 | Turning Point Health LLC | General Practice | 736 W Main St, Jenks, OK 74037-3519 | 2016-07-12 |
| 1891149647 | Daniel Enriquez | General Practice | 1040 7050 S Air Depot Blvd, Oklahoma City, OK 73135 | 2016-04-18 |
| Find all providers with the same taxonomy | ||||
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| 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.