Provider Demographics
NPI:1649440488
Name:DAVID K. ELLIOTT, DPM.
Entity type:Organization
Organization Name:DAVID K. ELLIOTT, DPM.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-630-9030
Mailing Address - Street 1:20 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2802
Mailing Address - Country:US
Mailing Address - Phone:330-630-9030
Mailing Address - Fax:330-630-3554
Practice Address - Street 1:20 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2802
Practice Address - Country:US
Practice Address - Phone:330-630-9030
Practice Address - Fax:330-630-3554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001901332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0458320Medicaid
OHT80492Medicare UPIN
OH0414220001Medicare NSC
OH0483912Medicare PIN