1548683279 NPI number — ELITE HEALTHCARE SOUTH DALLAS

Table of content: (NPI 1548683279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548683279 NPI number — ELITE HEALTHCARE SOUTH DALLAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELITE HEALTHCARE SOUTH DALLAS
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:
1548683279
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1752
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-417-9922
Provider Business Mailing Address Fax Number:
972-417-9605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4305 PINNACLE POINT DR.
Provider Second Line Business Practice Location Address:
# 301
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-337-2100
Provider Business Practice Location Address Fax Number:
214-337-2108
Provider Enumeration Date:
01/31/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WHISLER-PARVIN
Authorized Official First Name:
JEN
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
COLLECTIONS COORD.
Authorized Official Telephone Number:
972-417-9922

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  DC9745 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NR0400X , with the licence number: DC8314 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X , with the licence number: PT1107050 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0401X , with the licence number: DC9745 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0401X , with the licence number: DC8314 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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