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General NPI Number Information
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NPI Number | 1114142536
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Entity Type | Organization
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Legal Business Name | ELECTROCARDIOGRAPHY ASSOC PA
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 06/27/2012
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Provider Practice Location Address
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Address Line | 4803 WESLEY ST
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City | GREENVILLE
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State | TX
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Zip | 75401-5649
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Country | US
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Telephone | 903-454-8133
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9234
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City | GREENVILLE
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State | TX
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Zip | 75404-9234
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Country | US
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Telephone | 903-454-8133
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Fax |
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Authorized Official
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Title or Position | SEC. TREA.
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Name | DR. TIM ELLINGTON
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Credential | M.D.
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Telephone | 903-454-8133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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