NPIMap

Organization Active NPI

Ellis Rehabilitation Services, Inc.

  • Rehabilitation Clinic/Center
  • Tyler, TX
National Provider Identifier
1245240365
Registry record updated Feb 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
ELLIS REHABILITATION SERVICES, INC.
Practice address
5609 Donnybrook Ave
Tyler, TX 75703-6111
Phone
(903) 561-2808
Fax
(903) 939-1812
NPI assigned
Aug 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. David Ellis, PT
Title
President/Administrator
Phone
(903) 675-0000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

5609 Donnybrook Ave
Tyler, TX 75703-6111

Mailing address

115 S Murchison St
Athens, TX 75751-2662
Phone (903) 675-0000

Other identifiers 4

IdentifierTypeStateIssuer
0094BGOtherTXBCBS
110019002MedicaidTX
122300OtherTXCHIPS
110019004MedicaidTX

National Provider Directory

National Provider Directory

Locations

627 S Palestine St
Athens, TX 75751
Phone (903) 675-0000

102 E Grand Plz
Grand Saline, TX 75140
Phone (903) 962-7901

5609 Donnybrook Ave
Tyler, TX 75703
Phone (903) 561-2808

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265673600000",
    "number": "1245240365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 S MURCHISON ST",
            "city": "ATHENS",
            "state": "TX",
            "postal_code": "757512662",
            "telephone_number": "903-675-0000",
            "fax_number": "903-675-5520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5609 DONNYBROOK AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757036111",
            "telephone_number": "903-561-2808",
            "fax_number": "903-939-1812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLIS REHABILITATION SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-09",
        "last_updated": "2010-02-09",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT/ADMINISTRATOR",
        "authorized_official_telephone_number": "903-675-0000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0094BG",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110019002",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIPS",
            "identifier": "122300",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110019004",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.