| Elite Np Clinic Pllc | |
|
412 E Pleasant Run Rd Ste B Desoto TX 75115-3936 | |
| (682) 325-9617 | |
| Not Available |
| Full Name | Elite Np Clinic Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 412 E Pleasant Run Rd Ste B, Desoto, Texas |
| Authorized Official Name and Position | Tamara Washington (OWNER) |
| Authorized Official Contact | 4698573101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Np Clinic Pllc 412 E Pleasant Run Rd Ste B Desoto TX 75115-3936 Ph: () - | Elite Np Clinic Pllc 412 E Pleasant Run Rd Ste B Desoto TX 75115-3936 Ph: (682) 325-9617 |
| NPI Number | 1023532348 |
|---|---|
| Provider Enumeration Date | 07/28/2017 |
| Last Update Date | 03/02/2023 |
| Medicare PECOS PAC ID | 1850658899 |
|---|---|
| Medicare Enrollment ID | O20171130000572 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023532348 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |
| Provider Name | Tamara A Washington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679962286 PECOS PAC ID: 1658699137 Enrollment ID: I20150413001792 |
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