Provider Demographics
NPI:1467866566
Name:ELLIOTT, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7340 CROSSING PL
Mailing Address - Street 2:STE 50
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2708
Mailing Address - Country:US
Mailing Address - Phone:317-578-8980
Mailing Address - Fax:317-578-8988
Practice Address - Street 1:7340 CROSSING PL
Practice Address - Street 2:STE 50
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2708
Practice Address - Country:US
Practice Address - Phone:317-578-8980
Practice Address - Fax:317-578-8988
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN15D2076283291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory