1386881266 NPI number — ELITE URGENT CARE CORP

Table of content: (NPI 1386881266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386881266 NPI number — ELITE URGENT CARE CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELITE URGENT CARE CORP
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:
6
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:
1386881266
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1506
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85211-1506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-844-8588
Provider Business Mailing Address Fax Number:
480-844-8715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
652 E WARNER RD
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85296-3071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-892-5555
Provider Business Practice Location Address Fax Number:
480-545-3188
Provider Enumeration Date:
01/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GHANI
Authorized Official First Name:
ROD
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
614-264-6567

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , with the licence number:  14522 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X , with the licence number: OTC4649 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 406581 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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