Provider Demographics
NPI:1528389509
Name:ELITE PRIMARY CARE PA
Entity Type:Organization
Organization Name:ELITE PRIMARY CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASIF
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-910-0840
Mailing Address - Street 1:4004 MEDICAL PKWY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7854
Mailing Address - Country:US
Mailing Address - Phone:903-450-1515
Mailing Address - Fax:903-450-9466
Practice Address - Street 1:4004 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7854
Practice Address - Country:US
Practice Address - Phone:903-450-1515
Practice Address - Fax:903-450-9466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2391207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB 109980OtherMEDICARE GROUP PTAN