Provider Demographics
NPI:1609639178
Name:ELITE TOTAL WELLNESS PLLC
Entity Type:Organization
Organization Name:ELITE TOTAL WELLNESS PLLC
Other - Org Name:ELITE WOUND CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:214-842-9830
Mailing Address - Street 1:130 N PRESTON RD STE 329
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-3188
Mailing Address - Country:US
Mailing Address - Phone:469-915-5069
Mailing Address - Fax:469-915-5069
Practice Address - Street 1:130 N PRESTON RD STE 329
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-3188
Practice Address - Country:US
Practice Address - Phone:469-915-5069
Practice Address - Fax:469-915-5069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty