1134497514 NPI number — ELITE CLINICAL STUDIES, LLC

Table of content: (NPI 1134497514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134497514 NPI number — ELITE CLINICAL STUDIES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELITE CLINICAL STUDIES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134497514
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4520 E. INDIAN SCHOOL RD #1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-788-3437
Provider Business Mailing Address Fax Number:
602-840-4868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4520 E INDIAN SCHOOL RD STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85018-5434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-788-3437
Provider Business Practice Location Address Fax Number:
602-840-4868
Provider Enumeration Date:
12/13/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SAINE
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
GEORGE
Authorized Official Title or Position:
ADMINISTRATIVE DIRECTOR
Authorized Official Telephone Number:
602-788-3437

Provider Taxonomy Codes

  • Taxonomy code: 261QR1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)