Organization
ELIS MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY SCHRIMPF (COO)
(817) 355-8000
Entity
Organization
Contact information
Practice address
5207 HERITAGE AVE, COLLEYVILLE, TX 76034-5915
(817) 355-8000
(817) 553-3536
Mailing address
5207 HERITAGE AVE, COLLEYVILLE, TX 76034-5915
(817) 355-8000
(817) 553-3536
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0011CK
BCBS
TX
05
—
079735901
—
TX
01
—
2517940
AETNA
TX
01
—
6401723
CIGNA
TX
01
—
7300217
AETNA
TX
Enumeration date
02/23/2007
Last updated
05/09/2025
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