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NPI Code Detail

MEDICARE: JAMES C ELLIOTT

MEDICARE: JAMES C ELLIOTT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175T00000XPeer Specialist001176OH

General Provider Information

NPI Number : 1396399192
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES C ELLIOTT
Provider Business Mailing Address
First Line : 1804 E 55TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44103-3602
Country : US
Telephone Number : 216-417-4213
Fax Number :
Provider Business Practice Location Address
First Line : 1804 E 55TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44103-3602
Country : US
Telephone Number : 216-417-4213
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2019
Last Update Date : 07/30/2019

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Directions to “ JAMES C ELLIOTT ” Practice Location

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