1144395328 NPI number — ELITE PHYSICIANS, INC.

Table of content: (NPI 1144395328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144395328 NPI number — ELITE PHYSICIANS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELITE PHYSICIANS, INC.
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:
VINCENT B. BARKER, MD
Provider Other Organization Name Type Code:
3
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:
1144395328
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 HEATH PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABERDEEN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39730-2266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-346-3642
Provider Business Mailing Address Fax Number:
662-304-4002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 JACKSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABERDEEN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39730-3349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-369-6431
Provider Business Practice Location Address Fax Number:
662-369-6473
Provider Enumeration Date:
11/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BARKER
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT, CEO
Authorized Official Telephone Number:
662-346-3642

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  19004 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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