Healthcare Provider Details

I. General information

NPI: 1912410168
Provider Name (Legal Business Name): ELIZUR CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PARKVIEW DR STE 2
KITTANNING PA
16201-7158
US

IV. Provider business mailing address

9800A MCKNIGHT RD STE 200
PITTSBURGH PA
15237-6032
US

V. Phone/Fax

Practice location:
  • Phone: 844-628-8813
  • Fax: 800-933-1356
Mailing address:
  • Phone: 412-358-4523
  • Fax: 412-358-4518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6000008920
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number6000008920
License Number StatePA

VIII. Authorized Official

Name: BRENDA ROBERTS
Title or Position: BUSINESS SUPPORT MANAGER
Credential:
Phone: 412-358-4523