Provider Demographics
NPI:1285643015
Name:ELLIOTT FOOT AND ANKLE ASSOC, INC
Entity Type:Organization
Organization Name:ELLIOTT FOOT AND ANKLE ASSOC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-929-3331
Mailing Address - Street 1:2127 STATE RD
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1427
Mailing Address - Country:US
Mailing Address - Phone:330-929-3331
Mailing Address - Fax:330-929-5408
Practice Address - Street 1:2127 STATE RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1427
Practice Address - Country:US
Practice Address - Phone:330-929-3331
Practice Address - Fax:330-929-5408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001546E213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCJ0712OtherMEDICARE RR
OH0147326Medicaid
OH0953357Medicaid
OH000000166454OtherANTHEM GROUP #
OHCJ0712OtherMEDICARE RR
OH=========00OtherBWC GROUP #
OH0300810001Medicare NSC