Provider Demographics
NPI:1861973711
Name:ELITE URGENT CARE AND FAMILY HEALTH, LLC
Entity type:Organization
Organization Name:ELITE URGENT CARE AND FAMILY HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES-LONGORIA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:308-633-6202
Mailing Address - Street 1:820 W 42ND ST STE 2300
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-5016
Mailing Address - Country:US
Mailing Address - Phone:308-633-6202
Mailing Address - Fax:308-633-6203
Practice Address - Street 1:820 W 42ND ST STE 2300
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-5016
Practice Address - Country:US
Practice Address - Phone:308-672-0991
Practice Address - Fax:904-479-9575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111555363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty