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General NPI Number Information
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NPI Number | 1619675246
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Entity Type | Organization
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Legal Business Name | ELITE HEALTH GROUP LLC SOUTHSIDE
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Dates
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Enumeration Date | 02/22/2023
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Last Update Date | 02/23/2023
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Provider Practice Location Address
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Address Line | 1322 HWY 77
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City | SOUTHSIDE
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State | AL
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Zip | 35907
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Country | US
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Telephone | 256-900-3010
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Fax |
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Provider Business Mailing Address
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Address Line | 1322 HWY 77
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City | SOUTHSIDE
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State | AL
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Zip | 35907
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BILLER
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Name | PENNY STARGEL
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Credential |
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Telephone | 256-203-4844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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