Provider Demographics
NPI:1942670575
Name:ELITE PODIATRY INC
Entity Type:Organization
Organization Name:ELITE PODIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:HICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-541-7345
Mailing Address - Street 1:102 ESSEX CT
Mailing Address - Street 2:STE A
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-3160
Mailing Address - Country:US
Mailing Address - Phone:256-541-7345
Mailing Address - Fax:
Practice Address - Street 1:102 ESSEX CT
Practice Address - Street 2:STE A
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-3160
Practice Address - Country:US
Practice Address - Phone:256-541-7345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric