Organization
ELITE SPINE SERVICES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REKHA WAGLE (NPI ADMINISTRATOR)
(817) 756-8232
Entity
Organization
Contact information
Practice address
700 E MARSHALL AVE, LONGVIEW, TX 75601-5580
(817) 756-8236
Mailing address
2140 HALL JOHNSON RD, 102 # 128, GRAPEVINE, TX 76051-8753
(817) 756-8232
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
01/11/2021
Last updated
01/25/2021
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