MEDICARE: STEPHEN C. 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	207L00000X	Anesthesiology Physician	R5J54	MO
2	207L00000X	Anesthesiology Physician	04-21076	KS

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275515314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN C. ELLIS MD

Provider Business Mailing Address
First Line	:	8717 W 110TH ST
Second Line	:	SUITE 600
City	:	OVERLAND PARK
State	:	KS
Zip	:	66210-2144
Country	:	US
Telephone Number	:	913-428-2900
Fax Number	:	913-428-2951

Provider Business Practice Location Address
First Line	:	19600 E 39TH ST S
Second Line	:
City	:	INDEPENDENCE
State	:	MO
Zip	:	64057-2301
Country	:	US
Telephone Number	:	913-428-2900
Fax Number	:	913-428-2951

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	08/18/2014

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Directions to “ STEPHEN C. ELLIS MD” Practice Location

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