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NPI Code Detail

MEDICARE: LEATRICE ELLIOTT

MEDICARE: LEATRICE ELLIOTT
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
1174400000XSpecialistOH1257649OH

General Provider Information

NPI Number : 1497158166
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEATRICE ELLIOTT
Provider Business Mailing Address
First Line : 1500 W JEFFERSON ST
Second Line :
City : SPRINGFIELD
State : OH
Zip : 45506-1224
Country : US
Telephone Number : 937-505-2855
Fax Number : 937-505-2972
Provider Business Practice Location Address
First Line : 1500 W JEFFERSON ST
Second Line :
City : SPRINGFIELD
State : OH
Zip : 45506-1224
Country : US
Telephone Number : 937-505-2855
Fax Number : 937-505-2972
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2014
Last Update Date : 10/08/2014

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Directions to “ LEATRICE ELLIOTT ” Practice Location

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