1780193045 NPI number — ELITE MEDICAL CREDENTIALING & CONSULTING SERVICES

Table of content: KENNETH E. NOVICH MD (NPI 1851475826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780193045 NPI number — ELITE MEDICAL CREDENTIALING & CONSULTING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELITE MEDICAL CREDENTIALING & CONSULTING SERVICES
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:
1780193045
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 57712
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEBSTER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77598-7712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-753-6936
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1411 CHERRY SPRINGS CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSOURI CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77459-3469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-753-6936
Provider Business Practice Location Address Fax Number:
281-753-6936
Provider Enumeration Date:
09/29/2017

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIS
Authorized Official First Name:
LITA
Authorized Official Middle Name:
MICHELE
Authorized Official Title or Position:
OWNER/SENIOR SERVICE REPRESENTATIVE
Authorized Official Telephone Number:
281-753-6936

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X , with the licence number:  B566406 , 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)





Copyright © 2007-2025 www.npivalidator.com