Provider Demographics
NPI:1700235645
Name:ELITE PAIN & HEALTH PC
Entity Type:Organization
Organization Name:ELITE PAIN & HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-781-1220
Mailing Address - Street 1:13100 N WESTERN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-1431
Mailing Address - Country:US
Mailing Address - Phone:800-781-1220
Mailing Address - Fax:888-678-8616
Practice Address - Street 1:13100 N WESTERN AVE STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-1431
Practice Address - Country:US
Practice Address - Phone:800-781-1220
Practice Address - Fax:888-678-8616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-10
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty