Timothy William Ellison
Individual provider Active NPI Contractor · Chisholm, MN
NPI 1972191674 · NPPES record last updated Jan 7, 2021
Key facts
- NPI
- 1972191674
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- Practice address
- 306 6TH St SW
Chisholm, MN 55719-1932 - Phone
- (218) 996-3225
- NPI assigned
- Jan 7, 2021
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | Yes |
Addresses
Primary practice location
306 6TH St SW
Chisholm, MN 55719-1932
Mailing address
306 6TH St SW
Chisholm, MN 55719-1932
Phone (218) 996-3225
Other providers in Chisholm, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 7, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.