| Elis Medical Corporation | |
|
5207 Heritage Ave Colleyville TX 76034-5915 | |
| (817) 355-8000 | |
| (817) 553-3536 |
| Full Name | Elis Medical Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 5207 Heritage Ave, Colleyville, Texas |
| Authorized Official Name and Position | Jeffrey M Bullard (PRESIDENT) |
| Authorized Official Contact | 8173558000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elis Medical Corporation 5207 Heritage Ave Colleyville TX 76034-5915 Ph: (817) 355-8000 | Elis Medical Corporation 5207 Heritage Ave Colleyville TX 76034-5915 Ph: (817) 355-8000 |
| NPI Number | 1912032384 |
|---|---|
| Provider Enumeration Date | 02/23/2007 |
| Last Update Date | 01/20/2020 |
| Medicare PECOS PAC ID | 9133160088 |
|---|---|
| Medicare Enrollment ID | O20050520000350 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912032384 | NPI | - | NPPES |
| 7300217 | Other | TX | AETNA |
| 079735901 | Medicaid | TX | |
| 2517940 | Other | TX | AETNA |
| 6401723 | Other | TX | CIGNA |
| 0011CK | Other | TX | BCBS |
| Provider Name | Melinda D Harrell |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093731812 PECOS PAC ID: 2668497132 Enrollment ID: I20051013000457 |
| Provider Name | Jeffrey M Bullard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902855687 PECOS PAC ID: 3678514536 Enrollment ID: I20100208000813 |
| Provider Name | Brian J Nimphius |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1477735041 PECOS PAC ID: 9739177056 Enrollment ID: I20150605001377 |
| Provider Name | Ryan Andrew Matthiesen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326480732 PECOS PAC ID: 0345534533 Enrollment ID: I20180523001094 |
| Provider Name | Allison M Phelps |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1487816914 PECOS PAC ID: 8820244965 Enrollment ID: I20190603000274 |
| Provider Name | Jennifer A Pearlman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700537974 PECOS PAC ID: 8628461217 Enrollment ID: I20220202002694 |
| Provider Name | Joe Abraham Lin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700319373 PECOS PAC ID: 8224308440 Enrollment ID: I20220513000621 |
| Provider Name | Rashad Mohamed Riazuddin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851917363 PECOS PAC ID: 6507236882 Enrollment ID: I20230102000222 |
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