Provider Demographics
NPI:1336832229
Name:ELITE PRIMARY CARE AND TCM SERVICES
Entity Type:Organization
Organization Name:ELITE PRIMARY CARE AND TCM SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:804-467-1628
Mailing Address - Street 1:4795 BETHLEHEM RD STE G
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-2516
Mailing Address - Country:US
Mailing Address - Phone:804-467-1628
Mailing Address - Fax:804-716-1311
Practice Address - Street 1:4795 BETHLEHEM RD STE G
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2516
Practice Address - Country:US
Practice Address - Phone:804-467-1628
Practice Address - Fax:804-716-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty