NPIMap

Individual provider Active NPI

Zachary Wade Elliott, ATC

  • Athletic Trainer
  • Sikeston, MO
National Provider Identifier
1811377799
Registry record updated Jun 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
2014043303 Issued in MO
Practice address
201 Plaza Dr
Suite a
Sikeston, MO 63801-5105
Phone
(573) 472-2663
Fax
(573) 472-2669
NPI assigned
Jun 4, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 4, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X 2014043303 MO Primary

Addresses

Primary practice location

201 Plaza Dr
Suite a
Sikeston, MO 63801-5105

Mailing address

201 Plaza Dr
Suite a
Sikeston, MO 63801-5105
Phone (573) 472-2663

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
2014043303MOMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Missouri Delta Medical Center Past Accepting new patients
Missouri Delta Medical Center Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1433376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433376000000",
    "number": "1811377799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 PLAZA DR",
            "address_2": "SUITE A",
            "city": "SIKESTON",
            "state": "MO",
            "postal_code": "638015105",
            "telephone_number": "573-472-2663",
            "fax_number": "573-472-2669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 PLAZA DR",
            "address_2": "SUITE A",
            "city": "SIKESTON",
            "state": "MO",
            "postal_code": "638015105",
            "telephone_number": "573-472-2663",
            "fax_number": "573-472-2669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "ZACHARY",
        "middle_name": "WADE",
        "name_prefix": "Mr.",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-04",
        "last_updated": "2015-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MO",
            "license": "2014043303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sikeston, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2015; 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.