MEDICARE: DR. JOHN ARTHUR ELLIS D.O.

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	207Q00000X	Family Medicine Physician	34-00-6876	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000372264	OTHER	OH	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1154307601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ARTHUR ELLIS D.O.

Provider Business Mailing Address
First Line	:	4750 HEMPSTEAD STATION DR
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-5164
Country	:	US
Telephone Number	:	800-875-0136
Fax Number	:	934-619-4366

Provider Business Practice Location Address
First Line	:	600 N PICKAWAY ST
Second Line	:
City	:	CIRCLEVILLE
State	:	OH
Zip	:	43113-1447
Country	:	US
Telephone Number	:	740-474-2126
Fax Number	:	740-477-1022

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

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	08/09/2013

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Directions to “ DR. JOHN ARTHUR ELLIS D.O.” Practice Location

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