| George G Ellis Jr Md Inc | |
|
910 Boardman Canfield Rd Boardman OH 44512-4240 | |
| (330) 965-0832 | |
| (330) 965-0155 |
| Full Name | George G Ellis Jr Md Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 910 Boardman Canfield Rd, Boardman, Ohio |
| Authorized Official Name and Position | Lorraine Ellis (OFFICE MANAGER) |
| Authorized Official Contact | 3309650832 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| George G Ellis Jr Md Inc 910 Boardman Canfield Rd Boardman OH 44512-4240 Ph: (330) 965-0832 | George G Ellis Jr Md Inc 910 Boardman Canfield Rd Boardman OH 44512-4240 Ph: (330) 965-0832 |
| NPI Number | 1073708251 |
|---|---|
| Provider Enumeration Date | 09/11/2007 |
| Last Update Date | 09/19/2024 |
| Medicare PECOS PAC ID | 4284655051 |
|---|---|
| Medicare Enrollment ID | O20051208000828 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073708251 | NPI | - | NPPES |
| 0894500 | Medicaid | OH | |
| 2316989 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 35060641E (Ohio) | Primary |
| Provider Name | George G Ellis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366428484 PECOS PAC ID: 7214994524 Enrollment ID: I20041217000265 |
| Provider Name | Linda Lou Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396104519 PECOS PAC ID: 5890090831 Enrollment ID: I20160229001946 |
| Provider Name | Bassel Choufani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659539245 PECOS PAC ID: 5799850004 Enrollment ID: I20170518002379 |
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