Ellington, Amanda Susan
Ellington, Amanda Susan is an sole proprietor health care provider with primary practice located at 2770 3Rd Ave Ste 120 , Lake Charles LA 70601-8994. She recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as her primary health care specialty. Ellington, Amanda Susan can be contacted via phone (337) 494-4868.Contact Information
Primary practice address
2770 3Rd Ave Ste 120
Lake Charles LA 70601-8994
Phone: (337) 494-4868
Fax: (337) 494-4870
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 203251 | Louisiana |
Profile Details
| NPI number | 1023219110 |
|---|---|
| LBN Legal business name | Ellington, Amanda Susan |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 29th, 2007 |
| Last updated | Jun 9th, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1023219110 | NPPES |
| Louisiana | MEDICAID | 1099791 | |
| Louisiana | Other | MD.203251 |
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