Provider Demographics
NPI:1033499967
Name:TEXAS ELITE HEALTH CLINIC, LLC
Entity Type:Organization
Organization Name:TEXAS ELITE HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, FNP
Authorized Official - Phone:972-402-9700
Mailing Address - Street 1:PO BOX 116762
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75011-6762
Mailing Address - Country:US
Mailing Address - Phone:972-402-9700
Mailing Address - Fax:972-402-9706
Practice Address - Street 1:1304 VILLAGE CREEK DR
Practice Address - Street 2:SUITE 300-B
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4472
Practice Address - Country:US
Practice Address - Phone:972-402-9700
Practice Address - Fax:972-402-9706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-23
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX774439261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2971285-01Medicaid
TXTXB141633Medicare PIN
TX2971285-01Medicaid