Provider Demographics
NPI:1396182093
Name:ELITE MEN'S HEALTH
Entity Type:Organization
Organization Name:ELITE MEN'S HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-761-5532
Mailing Address - Street 1:311 S CHURCH ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-2913
Mailing Address - Country:US
Mailing Address - Phone:870-761-5532
Mailing Address - Fax:
Practice Address - Street 1:311 S CHURCH ST
Practice Address - Street 2:SUITE G
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-2913
Practice Address - Country:US
Practice Address - Phone:870-761-5532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization