Provider Demographics
NPI:1235481540
Name:ELITE SPECIALTY CLINICS, INC.
Entity Type:Organization
Organization Name:ELITE SPECIALTY CLINICS, INC.
Other - Org Name:ELITE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAUG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:701-774-0320
Mailing Address - Street 1:PO BOX 6358
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58802-6358
Mailing Address - Country:US
Mailing Address - Phone:701-774-0320
Mailing Address - Fax:701-774-0337
Practice Address - Street 1:512 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-5316
Practice Address - Country:US
Practice Address - Phone:701-774-0320
Practice Address - Fax:701-774-0337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR26168261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care