MEDICARE: ELITE SURGICAL SOLUTIONS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant
2	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1609718600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE SURGICAL SOLUTIONS PLLC

Provider Business Mailing Address
First Line	:	1545 E SOUTHLAKE BLVD STE 270
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-5564
Country	:	US
Telephone Number	:	817-748-2260
Fax Number	:	817-748-2263

Provider Business Practice Location Address
First Line	:	1545 E SOUTHLAKE BLVD STE 270
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-5564
Country	:	US
Telephone Number	:	817-748-2260
Fax Number	:	817-748-2263

Authorized Official
Title or Position	:	OWNER
Name	:	MELVIN JOSEPH ELIESON
Credential	:	MD
Telephone Number	:	817-748-2260

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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