Provider Demographics
NPI:1952539751
Name:ELITE MEDICDAL SERVICES
Entity Type:Organization
Organization Name:ELITE MEDICDAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIMONG
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUMANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-565-9355
Mailing Address - Street 1:2779 SUNRIDGE HEIGHTS PKWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:702-478-5480
Practice Address - Street 1:2779 SUNRIDGE HEIGHTS PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5050
Practice Address - Country:US
Practice Address - Phone:702-565-9355
Practice Address - Fax:702-478-5480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1006266151261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1124129655OtherNPI