Ellerbrock Spine and Soft Tissue Services LLC
Organization Active NPI Clinic/Center · Bluffton, OH
NPI 1205205259 · NPPES record last updated Feb 10, 2016
Key facts
- NPI
- 1205205259
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- License
- 2927 (OH)
- Legal business name
- ELLERBROCK SPINE AND SOFT TISSUE SERVICES LLC
- Practice address
- 120 N Main St
Suite a
Bluffton, OH 45817-1246 - Phone
- (419) 358-2222
- Fax
- (419) 358-2223
- NPI assigned
- Sep 21, 2015
- Organization subpart
- No
Authorized official
- Name
- Dr. Matthew P Ellerbrock, D.C.
- Title
- Owner
- Phone
- (419) 659-2271
Practitioners 6
-
Megan Marie Brodwolf, MPT
-
Debora Limauro Bogart, L.M.T.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160217000028 | OH | Part B Supplier - Clinic/Group Practice | 2466762356 |
Receives reassigned benefits from 2 practitioners Practice locations: Bluffton, OH |
National Provider Directory
Locations
120 N Main St
Bluffton, OH 45817
Phone (419) 358-2222
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | 2927 | OH | Yes |
Addresses
Primary practice location
120 N Main St
Suite a
Bluffton, OH 45817-1246
Mailing address
120 N. Main St.
Bluffton, OH 45817-1250
Phone (419) 358-2222
Other providers in Bluffton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 10, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.