Provider Demographics
NPI:1689736670
Name:ELLINGTON FIELD SATELLITE CLINIC
Entity Type:Organization
Organization Name:ELLINGTON FIELD SATELLITE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CDR
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-475-5182
Mailing Address - Street 1:COMDT (CG-1122) US COAST GUARD
Mailing Address - Street 2:2100 2ND ST STE 5314
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20593-0001
Mailing Address - Country:US
Mailing Address - Phone:202-475-5182
Mailing Address - Fax:
Practice Address - Street 1:COMMANDING OFFICER USCG AIR STATION HOUSTON
Practice Address - Street 2:1178 ELLINGTON FIELD
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034
Practice Address - Country:US
Practice Address - Phone:281-929-2421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient