MEDICARE: DR. RONALD B ELDER M.D., PSC

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	208000000X	Pediatrics Physician	34620	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	611349692	OTHER	KY	NATIONAL TELEPHONE COOPER
2	611349692	OTHER	KY	MISCELLANEOUS COMMERCIAL
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	611349692	OTHER	KY	HUMANA
5	611349692	OTHER	KY	UNITED HEALTH CARE
6	611349692	OTHER	KY	CHA
7	611349692	OTHER	KY	RESERVE NATIONAL
8	2364418006	OTHER	KY	CIGNA
9	48417	OTHER	KY	PHCS
10	5076198	OTHER	KY	AETNA US HEALTHCARE (MC)
11	611349692	OTHER	KY	CENTER CARE
12	1631299	OTHER	KY	FIRST HEALTH NETWORK
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	000000065383	OTHER	KY	ANTHEM
15	23J8	OTHER	KY	ANTHEM FEP
16	611349692	OTHER	KY	UNITED HEALTH CARE - RAIL

General Provider Information

NPI Number	:	1043217169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD B ELDER M.D., PSC

Provider Business Mailing Address
First Line	:	1623 NASHVILLE ST
Second Line	:	SUITE 201
City	:	RUSSELLVILLE
State	:	KY
Zip	:	42276-8889
Country	:	US
Telephone Number	:	270-726-3303
Fax Number	:	270-726-3910

Provider Business Practice Location Address
First Line	:	1623 NASHVILLE ST
Second Line	:	SUITE 201
City	:	RUSSELLVILLE
State	:	KY
Zip	:	42276-8889
Country	:	US
Telephone Number	:	270-726-3303
Fax Number	:	270-726-3910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	06/05/2014

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