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General NPI Number Information
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NPI Number | 1891473088
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Entity Type | Organization
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Legal Business Name | ELITE PRIMARY CARE AND WELLNESS, PLLC
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Dates
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Enumeration Date | 07/07/2023
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Last Update Date | 07/07/2023
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Provider Practice Location Address
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Address Line | 8713 MILWAUKEE AVE STE 100
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City | LUBBOCK
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State | TX
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Zip | 79424-0927
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Country | US
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Telephone | 806-407-5885
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Fax | 806-407-5883
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Provider Business Mailing Address
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Address Line | 8713 MILWAUKEE AVE STE 100
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City | LUBBOCK
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State | TX
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Zip | 79424-0927
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Country | US
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Telephone | 806-407-5885
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Fax | 806-407-5883
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Authorized Official
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Title or Position | MEMBER
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Name | TALYNN HARVEY
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Credential | PA
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Telephone | 432-559-4329
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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