Ellis, Jessica Laine
Ellis, Jessica Laine is an individual health care provider with primary practice located at 1435 G St , Springfield OR 97477-4113. She recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as her primary health care specialty. Ellis, Jessica Laine can be contacted via phone (541) 242-4812.Contact Information
Primary practice address
1435 G St
Springfield OR 97477-4113
Phone: (541) 242-4812
Fax: (541) 242-4813
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Sports Medicine | 207QS0010X | MD172850 | Oregon |
Profile Details
| NPI number | 1245270222 |
|---|---|
| LBN Legal business name | Ellis, Jessica Laine |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 7th, 2006 |
| Last updated | Dec 4th, 2015 - about 9 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 | 1245270222 | NPPES |
| Oregon | MEDICAID | 500694329 |
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