Provider Demographics
NPI:1194128306
Name:ELITE CARE FAMILY MEDICINE, LLC
Entity type:Organization
Organization Name:ELITE CARE FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:662-348-3342
Mailing Address - Street 1:571 MITCHELL ST
Mailing Address - Street 2:STE C
Mailing Address - City:GUNTOWN
Mailing Address - State:MS
Mailing Address - Zip Code:38849-8500
Mailing Address - Country:US
Mailing Address - Phone:662-348-3342
Mailing Address - Fax:662-348-2772
Practice Address - Street 1:571 MITCHELL ST
Practice Address - Street 2:STE C
Practice Address - City:GUNTOWN
Practice Address - State:MS
Practice Address - Zip Code:38849-8500
Practice Address - Country:US
Practice Address - Phone:662-255-8324
Practice Address - Fax:662-348-2772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS342261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care