Provider Demographics
NPI:1386881266
Name:ELITE URGENT CARE CORP
Entity type:Organization
Organization Name:ELITE URGENT CARE CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROD
Authorized Official - Middle Name:K
Authorized Official - Last Name:GHANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-264-6567
Mailing Address - Street 1:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85211-1506
Mailing Address - Country:US
Mailing Address - Phone:480-844-8588
Mailing Address - Fax:480-844-8715
Practice Address - Street 1:652 E WARNER RD
Practice Address - Street 2:SUITE 107
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3071
Practice Address - Country:US
Practice Address - Phone:480-892-5555
Practice Address - Fax:480-545-3188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC4649261QU0200X
AZ14522261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ406581OtherAHCCCS
AZ406581OtherAHCCCS