| Elite Patient Care Llc | |
|
315 Country Club Rd Corydon IN 47112-1751 | |
| (737) 226-6700 | |
| Not Available |
| Full Name | Elite Patient Care Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 315 Country Club Rd, Corydon, Indiana |
| Authorized Official Name and Position | Antonio Gamboa (PRESIDENT) |
| Authorized Official Contact | 7372266700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Patient Care Llc Po Box 108810 Oklahoma City OK 73101-8810 Ph: () - | Elite Patient Care Llc 315 Country Club Rd Corydon IN 47112-1751 Ph: (737) 226-6700 |
| NPI Number | 1942811765 |
|---|---|
| Provider Enumeration Date | 08/14/2020 |
| Last Update Date | 08/14/2020 |
| Medicare PECOS PAC ID | 3779900220 |
|---|---|
| Medicare Enrollment ID | O20200828000471 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942811765 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Autumn C Allgeier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568601805 PECOS PAC ID: 9234280546 Enrollment ID: I20090909000375 |
| Provider Name | Phyllis I Okolo |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1568691699 PECOS PAC ID: 0143589093 Enrollment ID: I20180122002737 |
| Provider Name | Larry Edwin Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659979268 PECOS PAC ID: 0446660526 Enrollment ID: I20201030000476 |
| Provider Name | Rhonda Kay Tabacchi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720675010 PECOS PAC ID: 6507279031 Enrollment ID: I20201230001626 |
| Provider Name | Gregory Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699253294 PECOS PAC ID: 4789937103 Enrollment ID: I20210226001421 |
| Provider Name | Emily Henigman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568023281 PECOS PAC ID: 8325374796 Enrollment ID: I20210301001115 |
| Provider Name | Brian Whyms |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821440066 PECOS PAC ID: 2365736378 Enrollment ID: I20240417004187 |
| Provider Name | Amanda Gillespie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477942092 PECOS PAC ID: 9638494537 Enrollment ID: I20240427001834 |
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