MEDICARE: ELITE PRIMARY CARE

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	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)	K4647	TX

General Provider Information

NPI Number	:	1467879171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE PRIMARY CARE

Provider Business Mailing Address
First Line	:	PO BOX 1210
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-0021
Country	:	US
Telephone Number	:	972-720-9943
Fax Number	:	972-720-0115

Provider Business Practice Location Address
First Line	:	14110 DALLAS PKWY
Second Line	:	SUITE 100
City	:	DALLAS
State	:	TX
Zip	:	75254-4326
Country	:	US
Telephone Number	:	972-720-9943
Fax Number	:	972-720-0115

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. CLAUDIA CASTANO
Credential	:	M.D.
Telephone Number	:	972-720-9943

Provider Enumeration Date	:	03/20/2014
Last Update Date	:	03/20/2014

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Directions to “ELITE PRIMARY CARE ” Practice Location

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