MEDICARE: KIRK 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
1	207Q00000X	Family Medicine Physician	023075	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639104169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRK ELLIOTT

Provider Business Mailing Address
First Line	:	PO BOX 187
Second Line	:
City	:	ARNAUDVILLE
State	:	LA
Zip	:	70512-0187
Country	:	US
Telephone Number	:	337-754-7254
Fax Number	:	337-754-8047

Provider Business Practice Location Address
First Line	:	410 OLIVE ST
Second Line	:
City	:	ARNAUDVILLE
State	:	LA
Zip	:	70512-0187
Country	:	US
Telephone Number	:	337-754-7254
Fax Number	:	337-754-8047

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	05/30/2008

Similar Medicare Providers

1003005752 — KIRK E. ELLIOTT, M.D. , LLC
Practice Location Address:

DR KIRK ELLIOT , 410 OLIVE ST.
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70512-0187

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1295924942 — PAUL M. REES M.D., APMC
Practice Location Address:

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1346238458 — TECHE MANOR NURSING HOME, LLC
Practice Location Address:

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1356303002 — DR. MARK FRANCIS OLIVIER MD
Practice Location Address:

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Practice Fax:

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1427122969 — PHC-OPELOUSAS LP
Practice Location Address:

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Directions to “ KIRK ELLIOTT ” Practice Location

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