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General NPI Number Information
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NPI Number | 1548488588
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Entity Type | Individual
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Provider Name | ANTHONY WAYNE ELLIOTT II KCSA
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Gender | Male
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 10/04/2018
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Provider Practice Location Address
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Address Line | 3300 JUSTINIAN
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-8630
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Country | US
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Telephone | 502-523-6317
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Fax | 812-288-1119
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Provider Business Mailing Address
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Address Line | 3300 JUSTINIAN
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-8630
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Country | US
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Telephone | 502-523-6317
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Fax | --
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | SA102
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License Number State | KY
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