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NPI Code Detail

MEDICARE: ANDREW ELLIS

MEDICARE: ANDREW ELLIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1760332639
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW ELLIS
Provider Business Mailing Address
First Line : PO BOX 189
Second Line :
City : ARDMORE
State : OK
Zip : 73402-0189
Country : US
Telephone Number : 580-319-7305
Fax Number : 580-319-7328
Provider Business Practice Location Address
First Line : 301 W 4TH ST
Second Line :
City : ADA
State : OK
Zip : 74820-3411
Country : US
Telephone Number : 580-257-2444
Fax Number : 580-257-2445
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2026
Last Update Date : 01/30/2026

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Directions to “ ANDREW ELLIS ” Practice Location

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