Provider Demographics
NPI:1649214586
Name:ELLINGTON, TIMOTHY (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:ELLINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75403-0957
Mailing Address - Country:US
Mailing Address - Phone:903-408-7750
Mailing Address - Fax:903-408-7802
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:903-408-7750
Practice Address - Fax:903-408-7802
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6603207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX807201OtherBLUE CROSS BLUE SHIELD
TX137940601Medicaid
TX807201Medicare PIN
TXF6603Medicare UPIN
TX137940601Medicaid