Basic Information
| Provider Information | |||||||||
| NPI: | 1952445058 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELROD | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | MARK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 950202 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402950202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5029696552 | ||||||||
| FaxNumber: | 5029693799 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 E CHESTNUT ST STE 303 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026295552 | ||||||||
| FaxNumber: | 6026293132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2007 | ||||||||
| LastUpdateDate: | 01/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 01/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | R1105 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 42545 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200967660 | 05 | IN | MEDICAID | 000026447T | 01 | KY | HUMANA - NIS | OTHER | 50024311 | 01 | KY | PASSPORT - NIS | OTHER | 6615945 | 01 | KY | CIGNA - NIS | OTHER | 000000620784 | 01 | KY | ANTHEM - NIS | OTHER | 105793 | 01 | KY | SIHO - NIS | OTHER | 00533139 | 01 | KY | MEDICARE - NIS | OTHER | 7100073850 | 01 | KY | MEDICAID KY (NIS) | OTHER | P00745275 | 01 | KY | RAILROAD MCR KY - NIS | OTHER | 3721116000 | 01 | KY | PASSPORT ADVTG - NIS | OTHER |