Healthcare Provider Details

I. General information

NPI: 1730727009
Provider Name (Legal Business Name): ELITE MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 GROCE RD
LYMAN SC
29365-1631
US

IV. Provider business mailing address

12 GROCE RD
LYMAN SC
29365-1631
US

V. Phone/Fax

Practice location:
  • Phone: 864-439-1345
  • Fax: 864-439-1346
Mailing address:
  • Phone: 864-439-1345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN PRIME
Title or Position: OWNER
Credential: DC
Phone: 704-473-4653