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General NPI Number Information
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NPI Number | 1467874537
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Entity Type | Individual
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Provider Name | SUSAN ELIZABETH ELLINGTON MD
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Gender | Female
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Dates
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Enumeration Date | 01/09/2014
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Last Update Date | 09/09/2020
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Provider Practice Location Address
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Address Line | 7659 HILLSIDE RD SUITE 300
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City | AMARILLO
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State | TX
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Zip | 79119
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Country | US
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Telephone | 806-322-3656
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Fax | 806-354-5689
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Provider Business Mailing Address
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Address Line | 2809 S TRAVIS
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City | AMARILLO
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State | TX
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Zip | 79109
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Country | US
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Telephone | 806-680-8997
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Fax | 806-354-5689
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | J5154
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | J5154
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License Number State | TX
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