MEDICARE: EDWARD C ELLIOTT III

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	213E00000X	Podiatrist	016-005738	IL
2	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	DP220790	OR

General Provider Information

NPI Number	:	1083957088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD C ELLIOTT III

Provider Business Mailing Address
First Line	:	PO BOX 1189
Second Line	:
City	:	CORVALLIS
State	:	OR
Zip	:	97339-1189
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 MEMORIAL DR STE 305
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62526-3999
Country	:	US
Telephone Number	:	217-876-4830
Fax Number	:	217-876-8385

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

Provider Enumeration Date	:	03/28/2013
Last Update Date	:	03/11/2026

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Directions to “ EDWARD C ELLIOTT III ” Practice Location

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