Elliott, Michael Chad

Elliott, Michael Chad is an sole proprietor health care provider with primary practice located at 2602 Saint Michael Dr Ste 302B , Texarkana TX 75503. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as his primary health care specialty. Elliott, Michael Chad can be contacted via phone (903) 794-4196.

Contact Information

Primary practice address
2602 Saint Michael Dr Ste 302B Texarkana TX 75503
Phone: (903) 794-4196
Fax: (903) 614-5190
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA12400 Texas
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X TEMPORARY Texas

Profile Details

NPI number 1306312822
LBN Legal business name Elliott, Michael Chad
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 23rd, 2018
Last updated May 7th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306312822 NPPES
Oklahoma MEDICAID 200859940A
Oklahoma Other P02599432

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