Basic Information
| Provider Information | |||||||||
| NPI: | 1063475689 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELLIOTT | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 331 | ||||||||
| Address2: | |||||||||
| City: | SHAWNEE MISSION | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662010331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134694244 | ||||||||
| FaxNumber: | 9134691939 | ||||||||
| Practice Location | |||||||||
| Address1: | 8929 PARALLEL PKWY | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 661121689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135964180 | ||||||||
| FaxNumber: | 9135964797 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2006 | ||||||||
| LastUpdateDate: | 07/28/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 426615 | KS | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100192390B | 05 | KS | MEDICAID |