Provider Demographics
NPI:1588405070
Name:ELITE URGENT CARE LLC
Entity type:Organization
Organization Name:ELITE URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:VANHAUEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-713-2651
Mailing Address - Street 1:1 S ROYAL ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36602-3234
Mailing Address - Country:US
Mailing Address - Phone:251-725-9008
Mailing Address - Fax:
Practice Address - Street 1:1 S ROYAL ST STE 2
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36602-3234
Practice Address - Country:US
Practice Address - Phone:251-725-9008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELITE URGENT CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care