Provider Demographics
NPI:1699738799
Name:MCELLIGOTT, THOMAS J (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:MCELLIGOTT
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 1:1924 US HIGHWAY 441 N
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-1922
Mailing Address - Country:US
Mailing Address - Phone:863-357-0540
Mailing Address - Fax:863-357-0546
Practice Address - Street 1:1924 US HIGHWAY 441 N
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1922
Practice Address - Country:US
Practice Address - Phone:863-357-0540
Practice Address - Fax:863-357-0546
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037617174400000X
FLME138251207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00570963BMedicaid
GA200020069OtherMEDICARE RAILROAD
GA00570963BMedicaid
GA20BDCKSMedicare PIN
GA20BDCKSMedicare ID - Type UnspecifiedMEDICARE PROVIDER