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General NPI Number Information
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NPI Number | 1487393393
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Entity Type | Organization
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Legal Business Name | ELITE MEDICINE PC
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Dates
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Enumeration Date | 05/31/2022
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 1525 ADDISON AVE E STE A2
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City | TWIN FALLS
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State | ID
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Zip | 83301-5300
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Country | US
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Telephone | 208-739-9961
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Fax | 208-739-9962
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Provider Business Mailing Address
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Address Line | 1525 ADDISON AVE E STE A2
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City | TWIN FALLS
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State | ID
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Zip | 83301-5300
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Country | US
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Telephone | 208-739-9961
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Fax | 208-739-9962
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Authorized Official
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Title or Position | OWNER
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Name | LINDSAY HUBSMITH
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Credential | PA
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Telephone | 208-358-3225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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