Ellis William Leroy, MD is a
Internal Medicine physician based in Payson, Utah. Ellis William Leroy is licensed to practice in Utah (license number 159570-1205) and his current practice location is 1120 E 100 N, # 1, Payson, Utah. He can be reached at his office (for appointments etc.) via phone at
(801) 465-4813.
NPI number for Ellis William Leroy is 1356432009 and his current mailing address is 1055 N 500 W, Credentialing Department, Provo, Utah. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1356432009.
Physician's Profile
| Full Name | Ellis William Leroy |
|---|
| Gender | Male |
|---|
| Speciality | Internal Medicine |
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| Location | 1120 E 100 N, Payson, Utah |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1356432009
- Provider Enumeration Date: 09/27/2006
- Last Update Date: 01/11/2010
Medical Identifiers
Medical identifiers for Ellis William Leroy such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1356432009 | NPI | - | NPPES |
| 22811 | Other | UT | PEHP |
| 36374 | Other | UT | DMBA |
| 870281028EWJ | Other | UT | EMIA |
| 110090648 | Other | UT | PALMETTO |
| 87028108000 | Medicaid | UT | |
| 04-00323 | Other | UT | UTAH HEALTHCARE |
| 10700660401 | Other | UT | IHC |
| QMXAF0342 | Other | UT | ALTIUS |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207R00000X | Internal Medicine | 159570-1205 (Utah) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ellis William Leroy is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Ellis William Leroy, MD
1055 N 500 W, Credentialing Department,
Provo, UT 84604-3305
Ph: (801) 429-8000 | Ellis William Leroy, MD
1120 E 100 N, # 1,
Payson, UT 84651
Ph: (801) 465-4813 |
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