MR. EDWARD C ELLIOTT II (NPI# 1790748119) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790748119 |
| Entity Type | Individual |
| Full Name | MR. EDWARD C ELLIOTT II |
| Credential | MD |
| Practice Address |
210 W. Mckinley Ave Ste 1 Decatur IL 62526 |
| Practice Telephone | 2178766600 |
| Practice Fax Number | 2178766606 |
| Mailing Telephone | 2178766600 |
| Mailing Fax Number | 2178766606 |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2015-07-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RX0202X |
Internal Medicine Specialization: Medical Oncology |
036078735 | IL | Allopathic & Osteopathic Physicians |
| Y | 2085R0001X |
Radiology Specialization: Radiation Oncology |
036-078735 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036-078735 | 05 | |
| IL | 036078735 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841402112 | Edward D Elliott | Acupuncturist | 181 Grandview Hts, Boone, NC 28607-8618 | 2007-05-07 |
| 1780616979 | Edward Albert Elliott | Psychiatry & Neurology | 3017 Santa Monica Blvd, Ste 307, Santa Monica, CA 90404-2534 | 2006-07-07 |
| 1518412105 | Edward Elliott IIi | Nurse Practitioner | 200 Creekside Dr, Dickson, TN 37055-2176 | 2016-08-24 |
| 1083957088 | Edward C Elliott IIi | Podiatrist | 2 Memorial Dr Ste 305, Decatur, IL 62526-3999 | 2013-03-28 |
| 1013953793 | Edward F. Elliott Jr. | Radiology | 17 Belmont Ave, Brattleboro, VT 05301-6613 | 2006-06-21 |
| Street Address |
210 W. MCKINLEY AVE STE 1 |
| City | DECATUR |
| State | IL |
| Zip Code | 62526 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992774459 | James L Wade IIi | Internal Medicine | 210 W. Mckinley Ave, Ste 1, Decatur, IL 62526 | 2006-03-16 |
| 1316950033 | Dolores A Estrada | Internal Medicine | 210 W. Mckinley Ave, Suite 1, Decatur, IL 62526 | 2006-08-14 |
| 1366467755 | Kristi M Toennies | Nurse Practitioner | 210 W. Mckinley Ave, Ste 1, Decatur, IL 62526 | 2006-07-13 |
| 1700846664 | Mary Anne Depaz | Radiology | 210 W. Mckinley Ave, Ste 2, Decatur, IL 62526 | 2006-03-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083100804 | Coalition | Non-emergency Medical Transport (VAN) | 2375 N Longwood Dr, Decatur, IL 62526 | 2018-07-04 |
| 1881116820 | Bria N Howard | Nurse's Aide | 606 E Warren St. Apt 609, Decatur, IL 62526 | 2017-07-12 |
| 1437683679 | Lutheran Child and Family Services | Foster Care Agency | 2826 N. Monroe Street, Decatur, IL 62526 | 2017-04-14 |
| 1083166326 | Whitney Miller | Pharmacist | 225 East Ash Ave, Decatur, IL 62526 | 2016-11-03 |
| 1487053369 | Central Illinois Health Associates, Inc | Preferred Provider Organization | 2300 N. Edward Street, Decatur, IL 62526 | 2014-08-18 |
| 1659787893 | Stephanie Marie Kanitsch | Obstetrics & Gynecology | 544 W Pershing Rd Ste A, Decatur, IL 62526 | 2014-07-09 |
| 1497169973 | Brian Hassinger | Audiologist-Hearing Aid Fitter | 2605 N Water St Ste 101, Decatur, IL 62526 | 2014-06-12 |
| 1891041570 | Decatur 2016 LLC | Dentist | 141 Epershing Rd, Decatur, IL 62526 | 2012-07-31 |
| 1558639005 | Larry Lee Christensen | Pharmacist | 225 Ash Ave, Decatur, IL 62526 | 2011-12-12 |
| 1174821540 | Nathan Pyle | Internal Medicine | 2 Memorial Dr Ste 101, Decatur, IL 62526 | 2011-03-08 |
| Find all providers in zip 62526 | ||||
| Taxonomy Code | 2085R0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Radiation Oncology |
| A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841384518 | Anna K. Fariss, Md, LLC | Radiology | 150 E Ponce De Leon, Avenue 120, Decatur, GA 30030-2543 | 2006-10-03 |
| 1851483572 | Renata Charissa Moore | Radiology | 1990 E Lake Shore Dr, Decatur, IL 62521-3811 | 2006-09-29 |
| 1851344006 | Guy Gregory Garrett | Radiology | 2010 S Ben Merritt Drive, Decatur, TX 76234 | 2006-05-18 |
| 1255381562 | Traci C Mccormick | Radiology | 1312 7th St Se, Decatur, AL 35601-3340 | 2006-05-10 |
| 1417914847 | Juan Godinez-puebla | Radiology | 2010 Ben Merritt Dr Unit A, Decatur, TX 76234-3853 | 2006-04-28 |
| 1972593028 | David A Holladay | Radiology | 2675 N Decatur Rd Ste G09, Decatur, GA 30033-6130 | 2005-10-28 |
| 1871580142 | Cancer Care Specialists of Central Illinois, S.c. | Radiology | 210 W Mckinley Ave, Suite 1, Decatur, IL 62526-5858 | 2005-10-03 |
| 1154709673 | Fjs Radiation Oncology Inc | Radiology | 2675 N Decatur Rd, G03, Decatur, GA 30033-6131 | 2015-05-16 |
| 1063663037 | Dekalb Medical Specialty Care Group LLC | Radiology | 2701 N Decatur Rd, Decatur, GA 30033-5918 | 2008-10-08 |
| 1700066255 | Gregory Echt, M.d., Pllc | Radiology | 2010 Ben Merritt Dr Unit A, Decatur, TX 76234-3853 | 2007-11-13 |
| Find all providers in DECATUR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.