Provider Demographics
NPI:1376192294
Name:ELITE PAIN & HEALTH PC
Entity Type:Organization
Organization Name:ELITE PAIN & HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-780-1220
Mailing Address - Street 1:PO BOX 5033
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-5033
Mailing Address - Country:US
Mailing Address - Phone:800-781-1220
Mailing Address - Fax:888-678-8616
Practice Address - Street 1:2020 S SERVICE RD
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5512
Practice Address - Country:US
Practice Address - Phone:800-781-1220
Practice Address - Fax:888-678-8616
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELITE PAIN & HEALTH PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty