Healthcare Provider Details

I. General information

NPI: 1265277172
Provider Name (Legal Business Name): ELITE COMPREHENSIVE CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 03/14/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13094 NC HIGHWAY 50
SURF CITY NC
28445
US

IV. Provider business mailing address

13094 NC HIGHWAY 50
SURF CITY NC
28445-6588
US

V. Phone/Fax

Practice location:
  • Phone: 910-222-7555
  • Fax:
Mailing address:
  • Phone: 910-222-7555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: TEGAN MARIE HADLEY
Title or Position: OWNER/FNP-C
Credential:
Phone: 910-222-7555