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General NPI Number Information
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NPI Number | 1184895252
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Entity Type | Organization
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Legal Business Name | ELITE MEDICAL CLINIC PLLC
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Dates
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Enumeration Date | 03/17/2008
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Last Update Date | 03/17/2008
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Provider Practice Location Address
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Address Line | 1725 E 19TH ST STE 202
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City | TULSA
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State | OK
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Zip | 74104-5419
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Country | US
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Telephone | 888-599-3330
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Fax |
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Provider Business Mailing Address
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Address Line | 7107 S YALE AVE # 341
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City | TULSA
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State | OK
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Zip | 74136-6308
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Country | US
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Telephone | 888-599-3330
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Fax | 888-599-3330
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Authorized Official
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Title or Position | MEMBER
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Name | PALLAVI AGARWAL
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Credential | MD
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Telephone | 888-599-3330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 23998
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License Number State | OK
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