Healthcare Provider Details

I. General information

NPI: 1205134715
Provider Name (Legal Business Name): ELITE MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 07/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1236 FM 2824
BEEVILLE TX
78102-8229
US

IV. Provider business mailing address

PO BOX 189
BEEVILLE TX
78104-0189
US

V. Phone/Fax

Practice location:
  • Phone: 361-358-1103
  • Fax:
Mailing address:
  • Phone: 361-358-1103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberM2475
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberM2475
License Number StateTX

VIII. Authorized Official

Name: ANDREA KAE CASTILLA
Title or Position: SOLE PROPRIETOR
Credential: R.N, M.S.N.
Phone: 361-358-1103