Provider Demographics
NPI:1154579605
Name:ELLINGTON, CHRISTOPHER (BMBS)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:ELLINGTON
Suffix:
Gender:
Credentials:BMBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6063
Mailing Address - Fax:904-539-4091
Practice Address - Street 1:1545 AIRPORT BLVD STE 2000
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8615
Practice Address - Country:US
Practice Address - Phone:850-416-6933
Practice Address - Fax:850-416-6934
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME172201208G00000X
MO2008023487208600000X
TN54552208G00000X
KYTP975208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100571670Medicaid
IN300021105Medicaid
TNQ024290Medicaid