| Dr Justin Daniel Ellett, MD, PHD | |
|
2687 Lake Park Drive, N Charleston, SC 29406 | |
| (843) 572-1010 | |
| (843) 569-1719 |
| Full Name | Dr Justin Daniel Ellett |
|---|---|
| Gender | Male |
| Speciality | Urology |
| Experience | 14 Years |
| Location | 2687 Lake Park Drive, N Charleston, South Carolina |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275827248 | NPI | - | NPPES |
| 335989 | Medicaid | SC | |
| 1275827248 | Other | SC | MEDCOST |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208800000X | Urology | 33598 (South Carolina) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Bon Secours-st Francis Xavier Hospital | Charleston, SC | Hospital |
| Trident Medical Center | Charleston, SC | Hospital |
| Roper Hospital | Charleston, SC | Hospital |
| Roper St Francis Hospital-berkely Inc | Moncks corner, SC | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Lowcountry Urology Clinics, Pa | 6406869247 | 14 |
| Entity Name | Lowcountry Urology Clinics, Pa |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1942242714 PECOS PAC ID: 6406869247 Enrollment ID: O20060724000104 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Justin Daniel Ellett, MD, PHD 641 Saint Andrews Blvd, Charleston, SC 29407-7165 Ph: (843) 766-4070 | Dr Justin Daniel Ellett, MD, PHD 2687 Lake Park Drive, N Charleston, SC 29406 Ph: (843) 572-1010 |
Benjamin K Mcinnes, MD Urology Medicare: Medicare Enrolled Practice Location: 2687 Lake Park Dr, N Charleston, SC 29406 Phone: 843-572-0097 | |
William H Holl, MD Urology Medicare: Medicare Enrolled Practice Location: 2687 Lake Park Dr, N Charleston, SC 29406 Phone: 843-572-1010 |