Provider Demographics
NPI:1386431864
Name:ELITE HEALTHCARE CLINIC LLC
Entity type:Organization
Organization Name:ELITE HEALTHCARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:D
Authorized Official - Last Name:CROTTS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:580-571-2275
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:MOORELAND
Mailing Address - State:OK
Mailing Address - Zip Code:73852-0207
Mailing Address - Country:US
Mailing Address - Phone:580-571-2275
Mailing Address - Fax:
Practice Address - Street 1:417 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:MOORELAND
Practice Address - State:OK
Practice Address - Zip Code:73852-7602
Practice Address - Country:US
Practice Address - Phone:580-994-2180
Practice Address - Fax:580-994-2184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty