| Elite Medical Center Llc | |
|
12 Groce Rd Lyman SC 29365-1631 | |
| (864) 439-1345 | |
| (864) 439-1346 |
| Full Name | Elite Medical Center Llc |
|---|---|
| Speciality | Physical Medicine & Rehabilitation |
| Location | 12 Groce Rd, Lyman, South Carolina |
| Authorized Official Name and Position | Kevin Prime (OWNER) |
| Authorized Official Contact | 7044734653 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Medical Center Llc 12 Groce Rd Lyman SC 29365-1631 Ph: (864) 439-1345 | Elite Medical Center Llc 12 Groce Rd Lyman SC 29365-1631 Ph: (864) 439-1345 |
| NPI Number | 1730727009 |
|---|---|
| Provider Enumeration Date | 12/17/2019 |
| Last Update Date | 12/11/2024 |
| Medicare PECOS PAC ID | 6103256284 |
|---|---|
| Medicare Enrollment ID | O20230915003452 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730727009 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| 208100000X | Physical Medicine & Rehabilitation | (* (Not Available)) | Primary |
| Provider Name | Jay A Whitlock |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1073567012 PECOS PAC ID: 5496714099 Enrollment ID: I20041008000489 |
| Provider Name | Tracey Denise Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265818892 PECOS PAC ID: 3476854357 Enrollment ID: I20151217002464 |
| Provider Name | Syreeta Miller Dendy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043754005 PECOS PAC ID: 4880961465 Enrollment ID: I20170602000737 |
| Provider Name | Amber Bullard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023694163 PECOS PAC ID: 2264839869 Enrollment ID: I20210924000429 |
| Provider Name | Kevin Prime |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1649689969 PECOS PAC ID: 3375865280 Enrollment ID: I20240410002884 |
| Provider Name | Jed R Ellenburg |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1093441685 PECOS PAC ID: 3678099348 Enrollment ID: I20250424003630 |
Fig Tree Medical Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 12315 Greenville Hwy, Lyman, SC 29365 Phone: 864-439-4376 Fax: 864-439-4385 | |
Prime Health Solutions Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 206 Elliott Rd, Lyman, SC 29365 Phone: 864-485-2172 | |
Middle Tyger Community Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 84 Groce Rd, Lyman, SC 29365 Phone: 864-439-7760 Fax: 864-439-7034 |