ELLIS JOHN CIVELLO MD NPI 1063507432

NPI Information

NPI: 1063507432
Provider Name: ELLIS JOHN CIVELLO, MD
Classification: Psychiatry & Neurology - 2084P0805X
Entity Type: Individual

Specialization: Geriatric Psychiatry

Address:
721 THOMPSON DRIVE
KERRVILLE, TX
ZIP 78028
Phone: (830) 896-2211
Get Directions

Ellis John Civello, MD is a geriatric psychiatry psychiatry neurology in Kerrville, TX. The provider is geriatric Psychiatry is a subspecialty with psychiatric expertise in prevention, evaluation, diagnosis and treatment of mental and emotional disorders in the elderly, and improvement of psychiatric care for healthy and ill elderly patients. Ellis John Civello, MD NPI is 1063507432. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

721 THOMPSON DRIVE
KERRVILLE, TX
ZIP 78028
Phone: (830) 896-2211

The enumeration date for this NPI number is 10/3/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2084P0805X	Psychiatry & Neurology	Geriatric Psychiatry	G7046	TEXAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	B21871	MEDICARE UPIN
2	8D1118	MEDICARE ID-TYPE UNSPECIFIED	TEXAS
3	139933924	MEDICAID	TEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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