Provider Demographics
NPI:1689322588
Name:ELITE MEDICINE LLC
Entity Type:Organization
Organization Name:ELITE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-366-8494
Mailing Address - Street 1:8240 BECKETT PARK DR STE A
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-9313
Mailing Address - Country:US
Mailing Address - Phone:513-860-2888
Mailing Address - Fax:513-860-9507
Practice Address - Street 1:8240 BECKETT PARK DR STE A
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-9313
Practice Address - Country:US
Practice Address - Phone:513-860-2888
Practice Address - Fax:513-860-9507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty