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General NPI Number Information
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NPI Number | 1609648062
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Entity Type | Organization
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Legal Business Name | ELITE INTEGRAL STAFFING LLC
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Dates
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Enumeration Date | 10/27/2023
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 1800 W UNIVERSITY BLVD
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City | DURANT
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State | OK
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Zip | 74701-3006
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Country | US
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Telephone | 719-688-1483
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Fax |
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Provider Business Mailing Address
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Address Line | 4019 W HIGHWAY 70 STE 309
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City | DURANT
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State | OK
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Zip | 74701-4591
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Country | US
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Telephone | 719-688-1483
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL GLEN CRANFORD
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Credential | DO
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Telephone | 719-688-1483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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