Provider Demographics
NPI:1780193045
Name:ELITE MEDICAL CREDENTIALING & CONSULTING SERVICES
Entity Type:Organization
Organization Name:ELITE MEDICAL CREDENTIALING & CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SENIOR SERVICE REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LITA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-753-6936
Mailing Address - Street 1:PO BOX 57712
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-7712
Mailing Address - Country:US
Mailing Address - Phone:281-753-6936
Mailing Address - Fax:
Practice Address - Street 1:1411 CHERRY SPRINGS CT
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3469
Practice Address - Country:US
Practice Address - Phone:281-753-6936
Practice Address - Fax:281-753-6936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-29
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXB566406302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization