Provider Demographics
NPI:1700217189
Name:ELITE HEALTHCARE OF MUNCIE INC.
Entity Type:Organization
Organization Name:ELITE HEALTHCARE OF MUNCIE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-281-8883
Mailing Address - Street 1:3417 W BETHEL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-7504
Mailing Address - Country:US
Mailing Address - Phone:765-281-8883
Mailing Address - Fax:765-281-8884
Practice Address - Street 1:3417 W BETHEL AVE STE A
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-7504
Practice Address - Country:US
Practice Address - Phone:765-281-8883
Practice Address - Fax:765-281-8884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027232A207Q00000X
IN71003894B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty