Ellis, Rusty Todd
Ellis, Rusty Todd is an individual health care provider with primary practice located at 1025 New Moody Ln , La Grange KY 40031-9154. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Hospitalist, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Hospitalist is his primary health care specialty. Ellis, Rusty Todd can be contacted via phone (502) 222-8535.Contact Information
Primary practice address
1025 New Moody Ln
La Grange KY 40031-9154
Phone: (502) 222-8535
Fax: (502) 222-3932
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Hospitalist | 208M00000X | 43074 | Kentucky |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 43074 | Kentucky |
Profile Details
| NPI number | 1952439499 |
|---|---|
| LBN Legal business name | Ellis, Rusty Todd |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 28th, 2007 |
| Last updated | Dec 4th, 2020 - about 6 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1952439499 | NPPES |
| Kentucky | Other | 50026571 | PASSPORT |
| Kentucky | MEDICAID | 7100094070 | PASSPORT |
| Kentucky | Other | 000000633242 | PASSPORT |
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