MEDICARE: TERESA M. ELLIOTT,MDPA

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
1	261Q00000X	Clinic/Center	F5194	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00013Z	OTHER	TX	MEDICARE GROUP #

General Provider Information

NPI Number	:	1831344381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERESA M. ELLIOTT,MDPA

Provider Business Mailing Address
First Line	:	12801 MIDWAY RD
Second Line	:	SUITE 217
City	:	DALLAS
State	:	TX
Zip	:	75244-6813
Country	:	US
Telephone Number	:	214-361-5070
Fax Number	:	972-241-5075

Provider Business Practice Location Address
First Line	:	12801 MIDWAY RD
Second Line	:	SUITE 217
City	:	DALLAS
State	:	TX
Zip	:	75244-6813
Country	:	US
Telephone Number	:	214-361-5070
Fax Number	:	972-241-5075

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TERESA MARIE ELLIOTT
Credential	:	MD
Telephone Number	:	214-361-5070

Provider Enumeration Date	:	11/25/2008
Last Update Date	:	02/23/2012

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