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1730133588

NPI Code Detail

MEDICARE: WILLIAM MARTIN ELLIOTT II MD

MEDICARE: WILLIAM MARTIN ELLIOTT II MD

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	207P00000X	Emergency Medicine Physician	13508	WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00309253	OTHER		RR MEDICARE BLUEFIELD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000143660	OTHER	WV	BLUE CROSS BLUE SHIELD
3	1003314	OTHER	WV	BRICKSTREET
4	3001609	OTHER	WV	BRICKSTREET
5	001827970	OTHER	WV	BLUE CROSS BLUE SHIELD
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730133588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM MARTIN ELLIOTT II MD

Provider Business Mailing Address
First Line	:	4750 HEMPSTEAD STATION DR
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-5164
Country	:	US
Telephone Number	:	800-875-0136
Fax Number	:	937-619-4150

Provider Business Practice Location Address
First Line	:	500 CHERRY ST
Second Line	:
City	:	BLUEFIELD
State	:	WV
Zip	:	24701-3306
Country	:	US
Telephone Number	:	304-327-1100
Fax Number	:

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	06/19/2013

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Directions to “ WILLIAM MARTIN ELLIOTT II MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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