Ellingson, Clinton

Ellingson, Clinton is an individual health care provider with primary practice located at 2100 Providence Way , Idaho Falls ID 83404-4951. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Ophthalmology, Allopathic & Osteopathic Physicians / Retina Specialist. Allopathic & Osteopathic Physicians / Retina Specialist is his primary health care specialty. Ellingson, Clinton can be contacted via phone (208) 529-6600.

Contact Information

Primary practice address
2100 Providence Way Idaho Falls ID 83404-4951
Phone: (208) 529-6600
Fax: (208) 529-6602
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 49026 Kentucky
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 01080410A Indiana
Allopathic & Osteopathic Physicians / Retina Specialist 207WX0107X 49026 Kentucky
Allopathic & Osteopathic Physicians / Retina Specialist 207WX0107X M-15285 Idaho

Profile Details

NPI number 1326332776
LBN Legal business name Ellingson, Clinton
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 2nd, 2011
Last updated Aug 5th, 2021 - about 5 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326332776 NPPES
West Virginia MEDICAID 1326332776
West Virginia MEDICAID 0160321
West Virginia MEDICAID 1326332776
West Virginia MEDICAID 7100279250
West Virginia MEDICAID 300021246

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