Provider Demographics
NPI:1740298868
Name:ELITE CARE MEDICAL SERVICES INC
Entity type:Organization
Organization Name:ELITE CARE MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SPICER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-251-6524
Mailing Address - Street 1:7447 HARWIN DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-2016
Mailing Address - Country:US
Mailing Address - Phone:832-251-6524
Mailing Address - Fax:832-251-6529
Practice Address - Street 1:7447 HARWIN DR
Practice Address - Street 2:SUITE 109
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2016
Practice Address - Country:US
Practice Address - Phone:832-251-6524
Practice Address - Fax:832-251-6529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170952901Medicaid
TX0A5606Medicare PIN
TX00733XMedicare PIN