Provider Demographics
NPI:1184052854
Name:TOM ELSBURY INSURANCE AGENCY LLC
Entity type:Organization
Organization Name:TOM ELSBURY INSURANCE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ELSBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-682-3234
Mailing Address - Street 1:201 S ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65240-1385
Mailing Address - Country:US
Mailing Address - Phone:573-682-3234
Mailing Address - Fax:
Practice Address - Street 1:201 S ALLEN ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:MO
Practice Address - Zip Code:65240-1385
Practice Address - Country:US
Practice Address - Phone:573-682-3234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0405832251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management