MEDICARE: ELITE MD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM1300X	Multi-Specialty Clinic/Center
2	261QP2300X	Primary Care Clinic/Center
3	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1942829346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE MD

Provider Business Mailing Address
First Line	:	2855 S BRONCO ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5207
Country	:	US
Telephone Number	:	702-329-9002
Fax Number	:	702-745-2182

Provider Business Practice Location Address
First Line	:	2855 S BRONCO ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5207
Country	:	US
Telephone Number	:	702-730-0926
Fax Number	:	702-926-9658

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ELSIE JUMAO-AS
Credential	:
Telephone Number	:	702-793-5280

Provider Enumeration Date	:	04/15/2020
Last Update Date	:	01/27/2026

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Directions to “ELITE MD ” Practice Location

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