Provider Demographics
NPI:1114686045
Name:ELITE SURGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:ELITE SURGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ATALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIETOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-717-1547
Mailing Address - Street 1:17141 W SELDON LN
Mailing Address - Street 2:
Mailing Address - City:WADDELL
Mailing Address - State:AZ
Mailing Address - Zip Code:85355-7578
Mailing Address - Country:US
Mailing Address - Phone:602-717-1547
Mailing Address - Fax:
Practice Address - Street 1:14877 W BELL RD STE 101
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-7610
Practice Address - Country:US
Practice Address - Phone:602-717-1547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty
No163WS0121XNursing Service ProvidersRegistered NursePlastic SurgeryGroup - Single Specialty