Ellis, Ira Keith

Ellis, Ira Keith is an individual health care provider with primary practice located at 2084 W Main St , Milan TN 38358-3515. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Addiction Medicine. Allopathic & Osteopathic Physicians / Addiction Medicine is his primary health care specialty. Ellis, Ira Keith can be contacted via phone (615) 673-6737.

Contact Information

Primary practice address
2084 W Main St Milan TN 38358-3515
Phone: (615) 673-6737
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 38294 Tennessee
Allopathic & Osteopathic Physicians / Addiction Medicine 207QA0401X 38294 Tennessee

Profile Details

NPI number 1922005388
LBN Legal business name Ellis, Ira Keith
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 30th, 2005
Last updated Jan 10th, 2024 - about 11 months 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 1922005388 NPPES
Tennessee Other 34018 TLC
Tennessee Other 626001636 TLC
Tennessee Other 4101718 TLC
Tennessee Other 5657408 TLC
Tennessee MEDICAID 3823013 TLC
Tennessee Other 626001636 TLC
Tennessee Other P00277818 TLC
Tennessee Other 4124210 TLC
Tennessee Other 626001636 TLC
Tennessee Other 166981 TLC
Tennessee MEDICAID 3895527 TLC

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