=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205875697
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELRINGTON MEDICAL CENTER PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2006
-----------------------------------------------------
Last Update Date | 02/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26611 W 7 MILE RD SUITE B
-----------------------------------------------------
City | REDFORD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48240-2063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-255-6500
-----------------------------------------------------
Fax | 313-255-3671
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | #6895 6895 RELIABLE PARKWAY
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60686-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-255-6500
-----------------------------------------------------
Fax | 313-255-3671
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | ERROL ELRINGTON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 313-255-6500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 4301060303
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 4301060303
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------