=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730218520
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J. SCOTT ELLIS, DO, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2007
-----------------------------------------------------
Last Update Date | 07/18/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3023 PERRYTON PKWY SUITE 205
-----------------------------------------------------
City | PAMPA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79065-2821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-665-9900
-----------------------------------------------------
Fax | 806-665-9905
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3023 PERRYTON PKWY SUITE 205
-----------------------------------------------------
City | PAMPA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79065-2821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-665-9900
-----------------------------------------------------
Fax | 806-665-9905
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE PROPRIETOR
-----------------------------------------------------
Name | DR. JIMMY SCOTT ELLIS
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 806-665-9900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | L6229
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------