| Elite Case Management Agency Llc | |
|
1700 University Blvd Ste 8 Jackson MS 39204-3907 | |
| (601) 863-0258 | |
| Not Available |
| Full Name | Elite Case Management Agency Llc |
|---|---|
| Speciality | General Practice |
| Location | 1700 University Blvd Ste 8, Jackson, Mississippi |
| Authorized Official Name and Position | Latosha Mcnair (CNO) |
| Authorized Official Contact | 6018630258 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Case Management Agency Llc 409 Bald Cypress Cv Terry MS 39170-6002 Ph: (601) 863-0258 | Elite Case Management Agency Llc 1700 University Blvd Ste 8 Jackson MS 39204-3907 Ph: (601) 863-0258 |
| NPI Number | 1871221549 |
|---|---|
| Provider Enumeration Date | 08/10/2022 |
| Last Update Date | 10/11/2022 |
| Medicare PECOS PAC ID | 0941676035 |
|---|---|
| Medicare Enrollment ID | O20221014000020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871221549 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Mackinzie Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982292926 PECOS PAC ID: 5991171837 Enrollment ID: I20221019000032 |
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