Provider Demographics
NPI:1992224349
Name:ELITE FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:ELITE FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:VISHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:AGGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-742-4900
Mailing Address - Street 1:3336 E 32ND ST STE 205
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-4454
Mailing Address - Country:US
Mailing Address - Phone:918-398-0800
Mailing Address - Fax:
Practice Address - Street 1:3336 E 32ND ST STE 205
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-4454
Practice Address - Country:US
Practice Address - Phone:918-398-0800
Practice Address - Fax:918-398-0810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200749030BMedicaid