Provider Demographics
NPI:1982892105
Name:ELITE ORTHOPAEDICS OF IRVING PLLC
Entity Type:Organization
Organization Name:ELITE ORTHOPAEDICS OF IRVING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-401-8726
Mailing Address - Street 1:PO BOX 100962
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0962
Mailing Address - Country:US
Mailing Address - Phone:615-373-7600
Mailing Address - Fax:615-373-7651
Practice Address - Street 1:6750 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2420
Practice Address - Country:US
Practice Address - Phone:214-496-9700
Practice Address - Fax:514-496-9707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192911901Medicaid
TX192911901Medicaid