Provider Demographics
NPI:1295542249
Name:NP MIKE ELROD PC
Entity type:Organization
Organization Name:NP MIKE ELROD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELROD
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:817-905-8001
Mailing Address - Street 1:3521 LAURENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-1290
Mailing Address - Country:US
Mailing Address - Phone:817-905-8001
Mailing Address - Fax:817-926-1865
Practice Address - Street 1:3521 LAURENWOOD DR
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-1290
Practice Address - Country:US
Practice Address - Phone:817-905-8001
Practice Address - Fax:817-926-1865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty