MEDICARE: DR. RICHARD BRADBURY ELLINGTON DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	2006010377	MO

General Provider Information

NPI Number	:	1619904844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD BRADBURY ELLINGTON DO

Provider Business Mailing Address
First Line	:	11304 W 143RD TER
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66221-8034
Country	:	US
Telephone Number	:	913-402-8798
Fax Number	:

Provider Business Practice Location Address
First Line	:	2411 HOLMES ST
Second Line	:	UMKC SCHOOL OF MEDICINE RESIDENCY PROGRAM M1-210
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-2792
Country	:	US
Telephone Number	:	816-235-6626
Fax Number	:	816-235-6629

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	07/08/2007

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