Provider Demographics
NPI:1902557366
Name:ELITE MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:ELITE MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLUSEYI
Authorized Official - Middle Name:
Authorized Official - Last Name:ABIOYE-AKANJI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP
Authorized Official - Phone:401-490-9550
Mailing Address - Street 1:1515 SMITH ST STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-2947
Mailing Address - Country:US
Mailing Address - Phone:401-490-9550
Mailing Address - Fax:401-490-9221
Practice Address - Street 1:1515 SMITH ST STE A
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02911-2947
Practice Address - Country:US
Practice Address - Phone:401-490-9550
Practice Address - Fax:401-490-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty