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NPI Code Detail

MEDICARE: MR. JONATHAN GREGORY ELLIOTT HIS

MEDICARE: MR. JONATHAN GREGORY ELLIOTT HIS
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
1237700000XHearing Instrument Specialist1338LA
2237700000XHearing Instrument SpecialistHA-696MS

General Provider Information

NPI Number : 1871177162
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JONATHAN GREGORY ELLIOTT HIS
Provider Business Mailing Address
First Line : 201 VICTORY BLVD STE 213
Second Line :
City : MONROE
State : LA
Zip : 71203-2006
Country : US
Telephone Number : 318-350-5922
Fax Number :
Provider Business Practice Location Address
First Line : 201 VICTORY BLVD STE 213
Second Line :
City : MONROE
State : LA
Zip : 71203-2006
Country : US
Telephone Number : 318-350-5922
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2021
Last Update Date : 12/09/2025

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