Provider Demographics
NPI:1205384773
Name:ELITE OPERATIVE SERVICES, P.C.
Entity Type:Organization
Organization Name:ELITE OPERATIVE SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE FIRST ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNFA
Authorized Official - Phone:817-917-5651
Mailing Address - Street 1:PO BOX 171
Mailing Address - Street 2:
Mailing Address - City:JUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:76247-9998
Mailing Address - Country:US
Mailing Address - Phone:817-917-5651
Mailing Address - Fax:
Practice Address - Street 1:13521 MANE CT
Practice Address - Street 2:
Practice Address - City:JUSTIN
Practice Address - State:TX
Practice Address - Zip Code:76247
Practice Address - Country:US
Practice Address - Phone:817-917-5651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207V00000X
TX208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty