Organization
ELITE CARE PHYSICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID DEJESUS (PRESIDENT)
(737) 747-2293
Entity
Organization
Contact information
Practice address
1111 S MAIN ST STE 119, GRAPEVINE, TX 76051-5577
(737) 747-2293
(737) 747-2294
Mailing address
508 MYRTLE CT, KELLER, TX 76248-2858
(737) 747-2293
(737) 747-2294
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
—
—
207QA0505X
Adult Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
208D00000X
General Practice Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
2251G0304X
Geriatric Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
Other
Enumeration date
09/06/2018
Last updated
06/14/2021
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