Provider Demographics
NPI:1336250851
Name:ELLIOTT, BRIAN K (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:K
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 Q ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-3609
Mailing Address - Country:US
Mailing Address - Phone:402-421-0904
Mailing Address - Fax:402-421-0946
Practice Address - Street 1:2116 W FAIDLEY AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4678
Practice Address - Country:US
Practice Address - Phone:308-398-5560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16225207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200311350AMedicaid
2808OtherMIDLANDS CHOICE
SD7713920Medicaid
NE470780857 34Medicaid
IA0586172Medicaid
MS207229501Medicaid
MO207229501Medicaid
NE39-00282OtherUHC
39-01296OtherUHC
NE35182OtherBCBS
NE35182OtherBCBS
MO207229501Medicaid
SD7713920Medicaid
NE266903Medicare PIN
2808OtherMIDLANDS CHOICE
KS200311350AMedicaid
MS207229501Medicaid