Provider Demographics
NPI:1942829346
Name:ELITE MD LLC
Entity type:Organization
Organization Name:ELITE MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:EDSEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-519-7300
Mailing Address - Street 1:2855 S BRONCO ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5207
Mailing Address - Country:US
Mailing Address - Phone:412-519-7300
Mailing Address - Fax:
Practice Address - Street 1:2855 S BRONCO ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5207
Practice Address - Country:US
Practice Address - Phone:702-730-0926
Practice Address - Fax:702-926-9658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty