Provider Demographics
NPI:1396937082
Name:ELITE MEDICAL CARE PLLC
Entity type:Organization
Organization Name:ELITE MEDICAL CARE PLLC
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 STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-4442
Mailing Address - Country:US
Mailing Address - Phone:918-742-4900
Mailing Address - Fax:918-742-4901
Practice Address - Street 1:3336 E. 32ND STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-4442
Practice Address - Country:US
Practice Address - Phone:918-742-4900
Practice Address - Fax:918-742-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207RH0002X
261Q00000X, 261QM1300X
OK23724207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK20026000CMedicaid
OK2001129820AMedicaid
OK600522405Medicare PIN
OK2001129820AMedicaid