Provider Demographics
NPI:1366869109
Name:ELYTE SURGICAL LLC
Entity Type:Organization
Organization Name:ELYTE SURGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-295-6703
Mailing Address - Street 1:4007 MCCULLOUGH AVE # 272
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-2420
Mailing Address - Country:US
Mailing Address - Phone:214-295-6703
Mailing Address - Fax:214-245-5267
Practice Address - Street 1:4007 MCCULLOUGH AVE # 272
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-2420
Practice Address - Country:US
Practice Address - Phone:214-295-6703
Practice Address - Fax:214-245-5267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty