Provider Demographics
NPI:1770965774
Name:ELITE HEALTH CARE OF JAY COUNTY INC
Entity type:Organization
Organization Name:ELITE HEALTH CARE OF JAY COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:SEGRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:765-281-8883
Mailing Address - Street 1:126 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:IN
Mailing Address - Zip Code:47336-1250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:126 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:IN
Practice Address - Zip Code:47336-1250
Practice Address - Country:US
Practice Address - Phone:765-281-8883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027232A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty