Provider Demographics
NPI:1245571835
Name:ELITE PRIMARY CARE
Entity Type:Organization
Organization Name:ELITE PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-720-9943
Mailing Address - Street 1:PO BOX 802834
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75380-2834
Mailing Address - Country:US
Mailing Address - Phone:972-720-9943
Mailing Address - Fax:972-386-7474
Practice Address - Street 1:4305 PINNACLE POINT DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-1311
Practice Address - Country:US
Practice Address - Phone:972-720-9943
Practice Address - Fax:972-386-7474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4647305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization