Provider Demographics
NPI:1154328250
Name:KNOX, ELLEN PORTER (MD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:PORTER
Last Name:KNOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 COMANCHE RD
Mailing Address - Street 2:
Mailing Address - City:FORT MEADE
Mailing Address - State:SD
Mailing Address - Zip Code:57741-1002
Mailing Address - Country:US
Mailing Address - Phone:605-347-2511
Mailing Address - Fax:612-725-1233
Practice Address - Street 1:113 COMANCHE RD
Practice Address - Street 2:
Practice Address - City:FORT MEADE
Practice Address - State:SD
Practice Address - Zip Code:57741-1002
Practice Address - Country:US
Practice Address - Phone:605-347-2511
Practice Address - Fax:612-725-1233
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY266562084P0800X, 2084P0800X
IN010395372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN160780OtherMEDICARE GROUP
41051000OtherMAGELLAN MIS
KY64266562Medicaid
INP00204278OtherRAILROAD MEDICARE
KY6764OtherMEDICARE GROUP
KY78903689OtherMEDICAID GROUP
IN100386460OtherMEDICAID GROUP
50704000OtherMAGELLAN GROUP
KYP00639807OtherRAILROAD MEDICARE
000000056294OtherANTHEM GROUP
000000344393OtherANTHEM ID #
IN100362960AMedicaid
1063415297OtherGROUP NPI
IN160860OtherMEDICARE GROUP
KY2444451000OtherPASSPORT ADVANTAGE GROUP
KY2703588000OtherPASSPORT ADVANTAGE
KY65927857OtherMEDICAID GROUP
KY82900176OtherMEDICAID GROUP
INCG3623OtherRAILROAD MEDICARE GROUP
KYCK2274OtherRAILROAD MEDICARE GROUP
E07379Medicare UPIN
KY676466Medicare PIN
IN160860OtherMEDICARE GROUP
KY64266562Medicaid