Basic Information
| Provider Information | |||||||||
| NPI: | 1003984857 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELLINGTON | ||||||||
| FirstName: | BEVERLY | ||||||||
| MiddleName: | TURNER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 INDEPENDENCE PT | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296154545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647976015 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 800 N A ST | ||||||||
| Address2: | |||||||||
| City: | EASLEY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296402144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648550001 | ||||||||
| FaxNumber: | 8648555030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 01/18/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 158067 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 9953 | SC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 102463DL | 01 | NY | PREFERRED CARE | OTHER | 1147117 | 05 | NY | MEDICAID | P010158067 | 01 | NY | BLUE CHOICE | OTHER | 158067CP | 01 | NY | WORKER'S COMP | OTHER | P010158067 | 01 | NY | BLUE SHIELD | OTHER | 099538 | 05 | SC | MEDICAID | 2697340 | 01 | NY | GHI | OTHER |