MEDICARE: JODI S ELLIOTT DO

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	5743	AK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	370022650	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1846375	OTHER	FIRST HEALTH PLAN
2	128703	OTHER	U CARE
3	1017253	OTHER	PREFERRED ONE
4	HP26565	OTHER	HEALTH PARTNERS
5	COMP	OTHER	MMSI
7	1202554	OTHER	MEDICA HEALTH PLANS
8	787139	OTHER	ARAZ GROUP AMERICAS PPO
9	293R7EL	OTHER	BLUE CROSS BLUE SHIELD
10	COMP	OTHER	CHAMPUS

General Provider Information

NPI Number	:	1558342626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI S ELLIOTT DO

Provider Business Mailing Address
First Line	:	3340 PROVIDENCE DR STE 500
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-4628
Country	:	US
Telephone Number	:	907-562-2423
Fax Number	:	907-563-1170

Provider Business Practice Location Address
First Line	:	3340 PROVIDENCE DR STE 500
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-4628
Country	:	US
Telephone Number	:	907-562-2423
Fax Number	:	907-563-1170

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	01/26/2011

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Directions to “ JODI S ELLIOTT DO” Practice Location

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