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NPI Code Detail

MEDICARE: KIRK E. ELLIOTT M.D. LLC

MEDICARE: KIRK E. ELLIOTT M.D. LLC
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
1363LA2200XAdult Health Nurse PractitionerLA
2207Q00000XFamily Medicine PhysicianLA

General Provider Information

NPI Number : 1871915389
Entity Type Code : Organization
Provider Name (Legal Business Name) : KIRK E. ELLIOTT M.D. LLC
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 : 70512-6154
Country : US
Telephone Number : 337-754-7254
Fax Number : 337-754-8047
Authorized Official
Title or Position : SOLE MEMBER
Name : KIRK E ELLIOTT
Credential : MD
Telephone Number : 337-754-7254
Provider Enumeration Date : 01/17/2014
Last Update Date : 01/17/2014

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