Dr Carolyn Ann Ellsworth, MD | |
312 N Kentucky St, West Plains, MO 65775-2073 | |
(417) 257-7076 | |
(417) 257-1417 |
Full Name | Dr Carolyn Ann Ellsworth |
---|---|
Gender | Female |
Speciality | Pediatrics - Adolescent Medicine |
Location | 312 N Kentucky St, West Plains, Missouri |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1679570618 | NPI | - | NPPES |
123942001 | Medicaid | AK | |
203592001 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2080A0000X | Pediatrics - Adolescent Medicine | 102421 (Missouri) | Primary |
Entity Name | Ozarks Medical Center |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1831115641 PECOS PAC ID: 3870491863 Enrollment ID: O20040209001035 |
Mailing Address | Practice Location Address |
---|---|
Dr Carolyn Ann Ellsworth, MD 312 N Kentucky St, West Plains, MO 65775-2073 Ph: (417) 257-7076 | Dr Carolyn Ann Ellsworth, MD 312 N Kentucky St, West Plains, MO 65775-2073 Ph: (417) 257-7076 |
Megan Marie Montague, Pediatrics Medicare: Medicare Enrolled Practice Location: 1137 Independence Dr, West Plains, MO 65775 Phone: 417-255-8464 | |
Joseph William Stafford Jr., Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 312 N Kentucky Ave, West Plains, MO 65775 Phone: 417-257-7076 Fax: 417-257-1417 | |
Dr. Garry Erskine Finke, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 1137 Independence Dr, West Plains, MO 65775 Phone: 417-293-8464 |