Provider Demographics
NPI:1689387433
Name:ELYSIAN MEDICAL CENTER 1-HOLLISTER LLC
Entity Type:Organization
Organization Name:ELYSIAN MEDICAL CENTER 1-HOLLISTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:469-559-9768
Mailing Address - Street 1:590 BIRCH RD STE 1C
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:MO
Mailing Address - Zip Code:65672-9607
Mailing Address - Country:US
Mailing Address - Phone:417-544-1241
Mailing Address - Fax:
Practice Address - Street 1:590 BIRCH RD STE 1C
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:MO
Practice Address - Zip Code:65672-9607
Practice Address - Country:US
Practice Address - Phone:414-544-1241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-26
Last Update Date:2023-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care