Provider Demographics
NPI:1003005752
Name:KIRK E. ELLIOTT, M.D. , LLC
Entity Type:Organization
Organization Name:KIRK E. ELLIOTT, M.D. , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-754-7254
Mailing Address - Street 1:DR KIRK ELLIOTT
Mailing Address - Street 2:PO BOX 187
Mailing Address - City:ARNAUDVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70512-0187
Mailing Address - Country:US
Mailing Address - Phone:337-754-7254
Mailing Address - Fax:337-754-8047
Practice Address - Street 1:DR KIRK ELLIOT
Practice Address - Street 2:410 OLIVE ST.
Practice Address - City:ARNAUDVILLE
Practice Address - State:LA
Practice Address - Zip Code:70512-0187
Practice Address - Country:US
Practice Address - Phone:337-754-7254
Practice Address - Fax:337-754-8047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023075173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1491063Medicaid
LA1491063Medicaid
LADD4292Medicare PIN
LA5CP69Medicare PIN