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General NPI Number Information
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NPI Number | 1841712650
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Entity Type | Organization
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Legal Business Name | BIS COMMUNITY CLINIC LLC
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Dates
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Enumeration Date | 07/13/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 22140 HIGHWAY 90 N
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City | BEDIAS
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State | TX
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Zip | 77831-5470
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Country | US
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Telephone | 936-241-3431
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Fax |
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Provider Business Mailing Address
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Address Line | 22140 HIGHWAY 90 N
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City | BEDIAS
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State | TX
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Zip | 77831-5470
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Country | US
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Telephone | 936-241-3431
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELIZABETH FUSELIER ELLIS
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Credential | NP
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Telephone | 936-241-3431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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