Healthcare Provider Details

I. General information

NPI: 1134318215
Provider Name (Legal Business Name): ELLIOTT-THOMAS HEALTH CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W KILPATRICK ST
MINEOLA TX
75773-2032
US

IV. Provider business mailing address

415 W KILPATRICK ST
MINEOLA TX
75773-2032
US

V. Phone/Fax

Practice location:
  • Phone: 903-569-2006
  • Fax: 903-569-2206
Mailing address:
  • Phone: 903-569-2006
  • Fax: 903-569-2206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL1568
License Number StateTX

VIII. Authorized Official

Name: DR. ROBERT M ELLIOTT
Title or Position: PHYSICIAN
Credential: MD
Phone: 903-569-2006