Provider Demographics
NPI:1114142536
Name:ELECTROCARDIOGRAPHY ASSOC PA
Entity Type:Organization
Organization Name:ELECTROCARDIOGRAPHY ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC. TREA.
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-454-8133
Mailing Address - Street 1:PO BOX 9234
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75404-9234
Mailing Address - Country:US
Mailing Address - Phone:903-454-8133
Mailing Address - Fax:
Practice Address - Street 1:4803 WESLEY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-5649
Practice Address - Country:US
Practice Address - Phone:903-454-8133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCS3178OtherRAILROAD MEDICARE
TX0828600-01Medicaid
00GT93Medicare PIN