Healthcare Provider Details

I. General information

NPI: 1386336188
Provider Name (Legal Business Name): ELITE WOUND CARE & ORTHOTICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 N TELSHOR BLVD STE H
LAS CRUCES NM
88011-8234
US

IV. Provider business mailing address

PO BOX 2845
LAS CRUCES NM
88004-2845
US

V. Phone/Fax

Practice location:
  • Phone: 575-202-2288
  • Fax: 575-222-1847
Mailing address:
  • Phone: 575-303-2929
  • Fax: 575-222-1847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAIME SANCHEZ
Title or Position: PRESIDENT
Credential:
Phone: 575-993-9890