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General NPI Number Information
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NPI Number | 1386993764
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Entity Type | Organization
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Legal Business Name | ELITE MEDICAL LLC
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Dates
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Enumeration Date | 08/31/2012
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Last Update Date | 10/24/2019
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Provider Practice Location Address
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Address Line | 1700 N UNION AVE
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City | ROSWELL
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State | NM
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Zip | 88201-3267
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Country | US
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Telephone | 575-623-1303
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Fax | 575-622-1903
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Provider Business Mailing Address
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Address Line | PO BOX 1974
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City | ROSWELL
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State | NM
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Zip | 88202-1974
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Country | US
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Telephone | 575-623-1303
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Fax | 575-622-1903
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Authorized Official
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Title or Position | OWNER
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Name | BARNIE P RODRIGUEZ
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Credential | PA
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Telephone | 575-623-1303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 93-PA21
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License Number State | NM
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