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Organization
MDASSISTLLC
Active
Organization
MDASSISTLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOM ELLIS (PRESIDENT)
(972) 937-7240
Entity
Organization
Contact information
Practice address
1626 W HIGHWAY 287 BUSINESS, 107, WAXAHACHIE, TX 75165-4712
(972) 937-7240
(972) 937-4255
Mailing address
1626 W HIGHWAY 287 BUSINESS, 107, WAXAHACHIE, TX 75165-4712
(972) 937-7240
(972) 937-4255
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
—
NULL
363AS0400X
Surgical Physician Assistant
—
—
367H00000X
Anesthesiologist Assistant
Primary
—
NULL
367H00000X
Anesthesiologist Assistant
Primary
—
—
Other
Enumeration date
04/21/2010
Last updated
04/21/2010
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