Provider Demographics
NPI:1114783479
Name:ELITE WELLNESS INTERNAL MEDICINE INC
Entity Type:Organization
Organization Name:ELITE WELLNESS INTERNAL MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP OF MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:KANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-728-0528
Mailing Address - Street 1:6615 W BOYNTON BEACH BLVD STE 412
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3526
Mailing Address - Country:US
Mailing Address - Phone:561-203-5282
Mailing Address - Fax:
Practice Address - Street 1:2300 S CONGRESS AVE STE 105
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-7400
Practice Address - Country:US
Practice Address - Phone:561-203-5282
Practice Address - Fax:740-212-8513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty