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General NPI Number Information
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NPI Number | 1831249499
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Entity Type | Organization
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Legal Business Name | SOUTHWEST REGIONAL ORTHOPEDIC SPORTS MEDICINE
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 08/28/2008
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Provider Practice Location Address
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Address Line | 1505 W JEFFERSON SUITE 102
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City | WAXAHACHIE
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State | TX
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Zip | 75165
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Country | US
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Telephone | 972-923-3800
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Fax | 972-351-9360
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Provider Business Mailing Address
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Address Line | PO BOX 381329
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City | DUNCANVILLE
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State | TX
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Zip | 75165
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Country | US
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Telephone | 972-923-3800
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Fax | 972-351-9360
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Authorized Official
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Title or Position | OWNER PROVIDER
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Name | DR. JAMES SCOTT ELLIS
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Credential | DO
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Telephone | 214-333-9175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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