Individual
JUSTIN ROSS ELLINGWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAA
Contact information
Practice address
1465 S GRAND BLVD, SAINT LOUIS, MO 63104-1003
(314) 617-2000
Mailing address
950 N MERIDIAN ST STE 500, INDIANAPOLIS, IN 46204-3908
(317) 962-4950
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
2025024808
MO
367H00000X
Anesthesiologist Assistant
75000041A
IN
Other
Enumeration date
06/06/2019
Last updated
07/08/2025
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