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General NPI Number Information
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NPI Number | 1164201778
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Entity Type | Organization
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Legal Business Name | ELITE CLINICAL PARTNERS LLC
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Dates
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Enumeration Date | 09/22/2023
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Last Update Date | 09/22/2023
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Provider Practice Location Address
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Address Line | 363 N SAM HOUSTON PKWY E STE 1100
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City | HOUSTON
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State | TX
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Zip | 77060-2413
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Country | US
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Telephone | 713-429-0502
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Fax | 713-429-0503
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Provider Business Mailing Address
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Address Line | 363 N SAM HOUSTON PKWY E STE 1100
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City | HOUSTON
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State | TX
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Zip | 77060-2413
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Country | US
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Telephone | 713-429-0502
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Fax | 713-429-0503
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Authorized Official
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Title or Position | OWNER
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Name | FELICIA BOUTTE
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Credential | PA
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Telephone | 713-562-8866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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