Provider Demographics
NPI:1366517690
Name:STRATA THERAPIES ELCOTT AND ASSOCIATES
Entity type:Organization
Organization Name:STRATA THERAPIES ELCOTT AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:ELCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RFO ABC CERTIFIED O
Authorized Official - Phone:205-824-2085
Mailing Address - Street 1:609 LORNA SQUARE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216
Mailing Address - Country:US
Mailing Address - Phone:205-824-2085
Mailing Address - Fax:205-824-2086
Practice Address - Street 1:609 LORNA SQUARE
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216
Practice Address - Country:US
Practice Address - Phone:205-824-2085
Practice Address - Fax:205-824-2086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL06010518332800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51048943OtherBLUE CROSS BLUE SHIELD
AL51048943OtherBLUE CROSS BLUE SHIELD