Provider Demographics
NPI:1871915389
Name:KIRK E. ELLIOTT M.D. LLC
Entity type:Organization
Organization Name:KIRK E. ELLIOTT M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:E
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-754-7254
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:ARNAUDVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70512-0187
Mailing Address - Country:US
Mailing Address - Phone:337-754-7254
Mailing Address - Fax:337-754-8047
Practice Address - Street 1:410 OLIVE ST
Practice Address - Street 2:
Practice Address - City:ARNAUDVILLE
Practice Address - State:LA
Practice Address - Zip Code:70512-6154
Practice Address - Country:US
Practice Address - Phone:337-754-7254
Practice Address - Fax:337-754-8047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207Q00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty