MEDICARE: ELITE MEDICAL CONSULTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1134829955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE MEDICAL CONSULTS

Provider Business Mailing Address
First Line	:	2906 E UNION HILLS DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-3430
Country	:	US
Telephone Number	:	602-341-3392
Fax Number	:

Provider Business Practice Location Address
First Line	:	6123 S RAINBOW BLVD STE B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3253
Country	:	US
Telephone Number	:	602-341-3392
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	JACKIE PINLAC
Credential	:	NP
Telephone Number	:	602-341-3392

Provider Enumeration Date	:	03/09/2023
Last Update Date	:	03/09/2023

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