Ellis Surgical Pavilion, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

ELLIS SURGICAL PAVILION, LLC

Practice address

1014 Ferris Ave
Ste. 214
Waxahachie, TX 75165-2599

Phone

(972) 938-1368

NPI assigned

Aug 16, 2007

Last updated

Aug 16, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. J. D. Fajardo, D.P.M.

Title

Ceo

Phone

(972) 938-1368

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1187222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187222400000",
    "number": "1336331917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1014 FERRIS AVE",
            "address_2": "STE. 214",
            "city": "WAXAHACHIE",
            "state": "TX",
            "postal_code": "751652599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1014 FERRIS AVE",
            "address_2": "STE. 214",
            "city": "WAXAHACHIE",
            "state": "TX",
            "postal_code": "751652599",
            "telephone_number": "972-938-1368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLIS SURGICAL PAVILION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-16",
        "last_updated": "2007-08-16",
        "status": "A",
        "authorized_official_last_name": "FAJARDO",
        "authorized_official_first_name": "J.",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "972-938-1368",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Waxahachie, TX
• Providers in Waxahachie, TX by specialty
• Ambulatory Surgical Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2007; 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.