Provider Demographics
NPI:1407507809
Name:ELITE GYNECOLOGY AND MED SPA
Entity Type:Organization
Organization Name:ELITE GYNECOLOGY AND MED SPA
Other - Org Name:AURORA HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARCE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:386-506-9528
Mailing Address - Street 1:2113 HARWOOD RD STE 309
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-4703
Mailing Address - Country:US
Mailing Address - Phone:386-506-9528
Mailing Address - Fax:
Practice Address - Street 1:255 W LEBANON STE 208
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75036-3404
Practice Address - Country:US
Practice Address - Phone:430-201-5004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-17
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty