Provider Demographics
NPI:1528164662
Name:ELLIOTT, ALLEN S (MD)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:S
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 1:200 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1661
Mailing Address - Country:US
Mailing Address - Phone:270-326-4800
Mailing Address - Fax:
Practice Address - Street 1:800 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1658
Practice Address - Country:US
Practice Address - Phone:270-326-4800
Practice Address - Fax:270-326-4820
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25846207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64258460Medicaid
KY25846OtherLICENSE
000000044241OtherBCBS PROVIDER NUMBER
0374536Medicare PIN
K076350Medicare PIN
KY64258460Medicaid
KY0601461Medicare PIN
KY1800398588Medicare PIN
0375055Medicare PIN
KY00280138Medicare PIN