Healthcare Provider Details

I. General information

NPI: 1780069138
Provider Name (Legal Business Name): ELITE OB-GYN SERVICES OF EL PASO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11040 VISTA DEL SOL DR
EL PASO TX
79935-4314
US

IV. Provider business mailing address

2000 HEALTH PARK DR
BRENTWOOD TN
37027-4692
US

V. Phone/Fax

Practice location:
  • Phone: 915-591-4624
  • Fax: 915-591-9291
Mailing address:
  • Phone: 615-373-7406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS WADLINGTON
Title or Position: GROUP VICE PRESIDENT/AO
Credential:
Phone: 615-372-7332