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General NPI Number Information
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NPI Number | 1225544158
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Entity Type | Organization
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Legal Business Name | ELYSIUM MEDICAL INCORPORATED
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Dates
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Enumeration Date | 12/14/2017
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Last Update Date | 12/14/2017
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Provider Practice Location Address
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Address Line | 3001 SAINT ROSE PKWY
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City | HENDERSON
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State | NV
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Zip | 89052-3839
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Country | US
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Telephone | 323-867-7907
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Fax |
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Provider Business Mailing Address
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Address Line | 3001 SAINT ROSE PKWY
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City | HENDERSON
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State | NV
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Zip | 89052-3839
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Country | US
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Telephone | 323-867-7907
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. ANDREW JONES
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Credential | MD
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Telephone | 323-867-7907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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