Healthcare Provider Details

I. General information

NPI: 1225946221
Provider Name (Legal Business Name): SAVANNAH ELLIS CPT, CCMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STONEWALL CREEK DR
O FALLON MO
63368-7591
US

IV. Provider business mailing address

300 STONEWALL CREEK DR
O FALLON MO
63368-7591
US

V. Phone/Fax

Practice location:
  • Phone: 636-293-7302
  • Fax:
Mailing address:
  • Phone: 636-293-7302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberJ2R9P6C2
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberJ2R9P6C2
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: