Provider Demographics
NPI:1346324514
Name:ELIZAGA & ELIZAGA ASSOCIATES, INC.
Entity Type:Organization
Organization Name:ELIZAGA & ELIZAGA ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TEODORA
Authorized Official - Middle Name:BALQUIEDRA
Authorized Official - Last Name:ELIZAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-282-5349
Mailing Address - Street 1:1524 SUNSET BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-1380
Mailing Address - Country:US
Mailing Address - Phone:740-282-5349
Mailing Address - Fax:740-282-5340
Practice Address - Street 1:1524 SUNSET BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-1380
Practice Address - Country:US
Practice Address - Phone:740-282-5349
Practice Address - Fax:740-282-5340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.037113207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1807015000OtherWV WELFARE PROVIDER #
OHA37113OtherHEALTH PLAN PROVIDER #
OH095443212001OtherMED MUT PROVIDER NUMBER
OH000000128366OtherBCBS PROVIDER NUMBER
OH0022513OtherBOX 24K MT STATE BCBS
OH095443212001OtherMED MUT PROVIDER NUMBER
OH1807015000OtherWV WELFARE PROVIDER #
OH095443212001OtherMED MUT PROVIDER NUMBER
OHA37113OtherHEALTH PLAN PROVIDER #
OHEL 9914491Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER