Provider Demographics
NPI:1578867271
Name:ELLITE MEDICAL SERVICES, INC
Entity Type:Organization
Organization Name:ELLITE MEDICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLIE
Authorized Official - Middle Name:NENE
Authorized Official - Last Name:OTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-718-0650
Mailing Address - Street 1:2664 WHISPERING TRL
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-6901
Mailing Address - Country:US
Mailing Address - Phone:214-718-0650
Mailing Address - Fax:
Practice Address - Street 1:2664 WHISPERING TRL
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-6901
Practice Address - Country:US
Practice Address - Phone:214-718-0650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03161363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ74612Medicare UPIN