Provider Demographics
NPI:1548683279
Name:ELITE HEALTHCARE SOUTH DALLAS
Entity type:Organization
Organization Name:ELITE HEALTHCARE SOUTH DALLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COLLECTIONS COORD.
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WHISLER-PARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-417-9922
Mailing Address - Street 1:PO BOX 1752
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034
Mailing Address - Country:US
Mailing Address - Phone:972-417-9922
Mailing Address - Fax:972-417-9605
Practice Address - Street 1:4305 PINNACLE POINT DR.
Practice Address - Street 2:# 301
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211
Practice Address - Country:US
Practice Address - Phone:214-337-2100
Practice Address - Fax:214-337-2108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPT1107050261QP2000X
TXDC9745261QR0401X, 111NR0400X
TXDC8314111NR0400X, 261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)Group - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty