| Elite Medical Center, Llc | |
|
114 Canal St Ste 201 Pooler GA 31322-4260 | |
| (912) 988-3839 | |
| Not Available |
| Full Name | Elite Medical Center, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 114 Canal St Ste 201, Pooler, Georgia |
| Authorized Official Name and Position | David A Jackson (PRESIDENT/OWNER) |
| Authorized Official Contact | 9129883839 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Medical Center, Llc 114 Canal St Ste 201 Pooler GA 31322-4260 Ph: (912) 988-3839 | Elite Medical Center, Llc 114 Canal St Ste 201 Pooler GA 31322-4260 Ph: (912) 988-3839 |
| NPI Number | 1982207437 |
|---|---|
| Provider Enumeration Date | 11/18/2020 |
| Last Update Date | 11/18/2020 |
| Medicare PECOS PAC ID | 9234542846 |
|---|---|
| Medicare Enrollment ID | O20201228001596 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982207437 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Erin Michelle Redmond |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053713560 PECOS PAC ID: 5890093074 Enrollment ID: I20160421001316 |
| Provider Name | Moshe Dekel |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1588717136 PECOS PAC ID: 1951368836 Enrollment ID: I20220525002561 |
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