Provider Demographics
NPI:1699914085
Name:RICKY L. MCELVAIN, MD, PA
Entity type:Organization
Organization Name:RICKY L. MCELVAIN, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCELVAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-784-1414
Mailing Address - Street 1:800 W ARBROOK BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-4327
Mailing Address - Country:US
Mailing Address - Phone:817-784-1414
Mailing Address - Fax:817-466-2853
Practice Address - Street 1:800 W ARBROOK BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4327
Practice Address - Country:US
Practice Address - Phone:817-784-1414
Practice Address - Fax:817-466-2853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2587261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE04069Medicare UPIN