| Organization Name: | ELITE PHC CORPORATION |
| NPI Number: | 1477602175 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GAINES LOUIS BURNS (CEO) |
| Mailing Address: | 220 E Ocean Blvd Los Fresnos |
| State: | TX US |
| Postal Code: | 785663227 |
| Phone Number: | 9562331202 |
| Fax Number: | 9562331175 |
| NPI Enumeration Date: | 01/10/2007 |
| NPI Last Update Date: | 03/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 007352 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |