Provider Demographics
NPI:1730727009
Name:ELITE MEDICAL CENTER LLC
Entity type:Organization
Organization Name:ELITE MEDICAL CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIME
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-473-4653
Mailing Address - Street 1:12 GROCE RD
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29365-1631
Mailing Address - Country:US
Mailing Address - Phone:864-439-1345
Mailing Address - Fax:
Practice Address - Street 1:12 GROCE RD
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:SC
Practice Address - Zip Code:29365-1631
Practice Address - Country:US
Practice Address - Phone:864-439-1345
Practice Address - Fax:864-439-1346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-17
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty