Ellis, Jared S

Ellis, Jared S is an individual health care provider with primary practice located at 2201 Jack Warner Pkwy , Tuscaloosa AL 35401-1090. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Ellis, Jared S can be contacted via phone (205) 523-5618.

Contact Information

Primary practice address
2201 Jack Warner Pkwy Tuscaloosa AL 35401-1090
Phone: (205) 523-5618
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 17418 Alabama

Profile Details

NPI number 1790785756
LBN Legal business name Ellis, Jared S
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 29th, 2005
Last updated Sep 1st, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790785756 NPPES
Alabama MEDICAID 1750393682
Alabama MEDICAID 541392605
Alabama Other 1750393682
Alabama MEDICAID 529700760
Alabama MEDICAID 541003926
Alabama MEDICAID 051037554

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