Anthony Wayne Elliott II, KCSA

Primary specialty

Surgical TechnologistTaxonomy code 246ZS0410X

License

SA102 Issued in KY

Practice address

3300 Justinian
Jeffersonville, IN 47130-8630

Phone

(502) 523-6317

Fax

(812) 288-1119

NPI assigned

Apr 23, 2007

Last updated

Oct 4, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538611200000",
    "number": "1548488588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 JUSTINIAN",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471308630",
            "telephone_number": "502-523-6317",
            "fax_number": "000-000-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 JUSTINIAN",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471308630",
            "telephone_number": "502-523-6317",
            "fax_number": "812-288-1119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "ANTHONY",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "credential": "KCSA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-23",
        "last_updated": "2018-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZS0410X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Technologist",
            "state": "KY",
            "license": "SA102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS",
            "identifier": "000000628536",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Parker Scott Edwards, OD
• John Bernard Eifler Jr., M.D.
• Nancy Jean Eklund, RN
• Elemental Body & Mind
• Elizabeth Tully, LCSW, LLC
• Barbara Elaine Elliott, NP
• Karen Lynn Ellmers, M.D.
• Aryahna Elmer, RBT
• Ema Anesthesia, PSC
• Emerald Care in

• Surgical Technologist in Jeffersonville, IN
• Providers in Jeffersonville, IN by specialty
• Surgical Technologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.