Individual
ANDREA M ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8288 S BROADWAY AVE, TYLER, TX 75703-5262
(903) 606-7060
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
BP10032729
TX
207Q00000X
Family Medicine Physician
Primary
N7419
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
284827701
—
TX
01
—
75-2616977-042
TRICARE
TX
01
—
752616977077
TRICARE
TX
01
—
752616977118
TRICARE
TX
01
—
8CU926
BCBS
TX
Enumeration date
09/15/2008
Last updated
12/03/2024
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us