Healthcare Provider Details

I. General information

NPI: 1902557366
Provider Name (Legal Business Name): ELITE MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2022
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 SMITH ST STE A
NORTH PROVIDENCE RI
02911-2947
US

IV. Provider business mailing address

1515 SMITH ST STE A
NORTH PROVIDENCE RI
02911-2947
US

V. Phone/Fax

Practice location:
  • Phone: 401-490-9550
  • Fax: 401-490-9221
Mailing address:
  • Phone: 401-490-9550
  • Fax: 401-490-9221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name: OLUSEYI ABIOYE-AKANJI
Title or Position: OWNER
Credential: DNP, FNP
Phone: 401-490-9550