Healthcare Provider Details

I. General information

NPI: 1295496685
Provider Name (Legal Business Name): ELITE PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S DON ROSER DR STE F1
LAS CRUCES NM
88011-4577
US

IV. Provider business mailing address

PO BOX 2845
LAS CRUCES NM
88004-2845
US

V. Phone/Fax

Practice location:
  • Phone: 575-303-2929
  • Fax: 575-233-6260
Mailing address:
  • Phone: 575-303-2929
  • Fax: 575-233-6260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

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