Provider Demographics
NPI:1235695040
Name:ELITE PROFESSIONAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:ELITE PROFESSIONAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRITO
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:817-525-5856
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75030-0938
Mailing Address - Country:US
Mailing Address - Phone:817-525-5856
Mailing Address - Fax:
Practice Address - Street 1:5128 BAYRIDGE CT.
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-4255
Practice Address - Country:US
Practice Address - Phone:817-525-5856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-17
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty