Provider Demographics
NPI:1770391765
Name:ELITE MED
Entity type:Organization
Organization Name:ELITE MED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:ROMEO
Authorized Official - Last Name:SALINAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DNP, FNP-C
Authorized Official - Phone:956-203-0474
Mailing Address - Street 1:1308 N US HIGHWAY 83 STE 3
Mailing Address - Street 2:
Mailing Address - City:ZAPATA
Mailing Address - State:TX
Mailing Address - Zip Code:78076-4127
Mailing Address - Country:US
Mailing Address - Phone:956-203-0474
Mailing Address - Fax:956-999-8515
Practice Address - Street 1:1308 N US HIGHWAY 83 STE 3
Practice Address - Street 2:
Practice Address - City:ZAPATA
Practice Address - State:TX
Practice Address - Zip Code:78076-4127
Practice Address - Country:US
Practice Address - Phone:956-203-0474
Practice Address - Fax:956-999-8515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-21
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX407626701Medicaid