Provider Demographics
NPI:1861732745
Name:ELITE PRIMARY CARE LLC
Entity type:Organization
Organization Name:ELITE PRIMARY CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLO
Authorized Official - Middle Name:L
Authorized Official - Last Name:PIKE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:931-245-1701
Mailing Address - Street 1:2690 MADISON STREET
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-0000
Mailing Address - Country:US
Mailing Address - Phone:931-245-1701
Mailing Address - Fax:931-245-1720
Practice Address - Street 1:2690 MADISON ST
Practice Address - Street 2:SUITE 130
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5975
Practice Address - Country:US
Practice Address - Phone:931-245-1701
Practice Address - Fax:931-245-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2297152W00000X
363L00000X, 363A00000X
TNDO1638207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty