Provider Demographics
NPI:1528228301
Name:ELITE INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:ELITE INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAENETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:NAPIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-769-3550
Mailing Address - Street 1:PO BOX 438
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46308-0438
Mailing Address - Country:US
Mailing Address - Phone:219-769-3550
Mailing Address - Fax:219-769-2642
Practice Address - Street 1:1242 SURREY CT
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-5239
Practice Address - Country:US
Practice Address - Phone:219-769-3550
Practice Address - Fax:219-769-2642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-14
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034369A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200901600AMedicaid
IN200901600AMedicaid