Healthcare Provider Details

I. General information

NPI: 1124036645
Provider Name (Legal Business Name): THOMAS JAMES ELLIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6810 PERIMETER DR STE 200
DUBLIN OH
43016-8013
US

IV. Provider business mailing address

340 POLARIS PKWY
WESTERVILLE OH
43082-7971
US

V. Phone/Fax

Practice location:
  • Phone: 614-827-8700
  • Fax: 614-827-8701
Mailing address:
  • Phone: 614-827-8700
  • Fax: 614-827-8701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35.089720
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD22134
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number35.089720
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: