MEDICARE: OREN HENRY ELLIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	66-2	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PROVO13053	OTHER		MOLINA
2	5421393	OTHER		CCN
3	10003858	OTHER		LOVELACE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	NM01VP02	OTHER	NM	BCBS NM
6	2335644	OTHER		UHC

General Provider Information

NPI Number	:	1780652396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OREN HENRY ELLIS MD

Provider Business Mailing Address
First Line	:	455 SAINT MICHAELS DR
Second Line	:	MEDICAL STAFF OFFICE
City	:	SANTA FE
State	:	NM
Zip	:	87505-7601
Country	:	US
Telephone Number	:	505-820-5227
Fax Number	:

Provider Business Practice Location Address
First Line	:	1631 HOSPITAL DR
Second Line	:	SUITE 200
City	:	SANTA FE
State	:	NM
Zip	:	87505-4728
Country	:	US
Telephone Number	:	505-424-0578
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	11/21/2007

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Directions to “ OREN HENRY ELLIS MD” Practice Location

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