MEDICARE: ELITE ER, 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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	J0811	TX

General Provider Information

NPI Number	:	1770815987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE ER, PLLC

Provider Business Mailing Address
First Line	:	10370 RICHMOND AVE
Second Line	:	STE 1375
City	:	HOUSTON
State	:	TX
Zip	:	77042-4141
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10370 RICHMOND AVE
Second Line	:	STE 1375
City	:	HOUSTON
State	:	TX
Zip	:	77042-4141
Country	:	US
Telephone Number	:	713-457-8444
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	DR. RONALD ALAN CHARLES
Credential	:	M.D.
Telephone Number	:	713-457-8444

Provider Enumeration Date	:	02/12/2010
Last Update Date	:	04/24/2012

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