Provider Demographics
NPI:1568699429
Name:ELEETE PHYSICIANS, LLC
Entity Type:Organization
Organization Name:ELEETE PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-358-1492
Mailing Address - Street 1:5700 OLD RICHMOND AVE
Mailing Address - Street 2:SUITE A-5
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1828
Mailing Address - Country:US
Mailing Address - Phone:804-358-1492
Mailing Address - Fax:804-358-1491
Practice Address - Street 1:5700 OLD RICHMOND AVE
Practice Address - Street 2:SUITE A-5
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1828
Practice Address - Country:US
Practice Address - Phone:804-358-1492
Practice Address - Fax:804-358-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239897261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1780893917Medicaid