MEDICARE: AMATHA M. ELLIOTT-GRAY

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1225297641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMATHA M. ELLIOTT-GRAY

Provider Business Mailing Address
First Line	:	6507 NW HILLDALE DR
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64151-2328
Country	:	US
Telephone Number	:	816-920-6084
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 CYPRESS AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64124-2145
Country	:	US
Telephone Number	:	816-920-6084
Fax Number	:

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

Provider Enumeration Date	:	06/02/2008
Last Update Date	:	06/02/2008

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