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General NPI Number Information
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NPI Number | 1861732745
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Entity Type | Organization
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Legal Business Name | ELITE PRIMARY CARE LLC
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Dates
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Enumeration Date | 02/28/2013
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Last Update Date | 06/02/2015
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Provider Practice Location Address
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Address Line | 2690 MADISON ST SUITE 130
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City | CLARKSVILLE
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State | TN
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Zip | 37043-5975
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Country | US
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Telephone | 931-245-1701
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Fax | 931-245-1720
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Provider Business Mailing Address
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Address Line | 2690 MADISON STREET SUITE 130
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City | CLARKSVILLE
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State | TN
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Zip | 37043-0000
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Country | US
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Telephone | 931-245-1701
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Fax | 931-245-1720
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. CARLO L PIKE
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Credential | DO
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Telephone | 931-245-1701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2297
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License Number State | TN
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO1638
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License Number State | TN
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