| Elite Patient Care Of Minnesota Pllc | |
|
5123 W 98th St Ste 2082 Minneapolis MN 55437-2040 | |
| (337) 408-0797 | |
| Not Available |
| Full Name | Elite Patient Care Of Minnesota Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 5123 W 98th St Ste 2082, Minneapolis, Minnesota |
| Authorized Official Name and Position | Antonio Gamboa (PRESIDENT) |
| Authorized Official Contact | 3374080797 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Patient Care Of Minnesota Pllc 1509 Dulles Dr Lafayette LA 70506-3718 Ph: (337) 408-0797 | Elite Patient Care Of Minnesota Pllc 5123 W 98th St Ste 2082 Minneapolis MN 55437-2040 Ph: (337) 408-0797 |
| NPI Number | 1083365084 |
|---|---|
| Provider Enumeration Date | 01/12/2022 |
| Last Update Date | 05/12/2023 |
| Medicare PECOS PAC ID | 6305233461 |
|---|---|
| Medicare Enrollment ID | O20220420002125 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083365084 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
| Provider Name | Hannah Leigh Hayes Oleary |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891284568 PECOS PAC ID: 6709131816 Enrollment ID: I20180613002204 |
| Provider Name | Brittany R Waletzko Bartz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184159014 PECOS PAC ID: 0345511853 Enrollment ID: I20201022003774 |
| Provider Name | Byron Kendall Herpich |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164629515 PECOS PAC ID: 6002931839 Enrollment ID: I20211218000127 |
| Provider Name | Vlastimil Smetka |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497974273 PECOS PAC ID: 1658424825 Enrollment ID: I20220602000553 |
| Provider Name | Amanda Gillespie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477942092 PECOS PAC ID: 9638494537 Enrollment ID: I20220603000508 |
| Provider Name | Jennifer Lothert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770207946 PECOS PAC ID: 0446628739 Enrollment ID: I20221117000519 |
| Provider Name | Marian Stokes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043562150 PECOS PAC ID: 9436394079 Enrollment ID: I20230109001844 |
| Provider Name | Brian Whyms |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821440066 PECOS PAC ID: 2365736378 Enrollment ID: I20230217001152 |
| Provider Name | Antonio Gamboa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154356780 PECOS PAC ID: 2264468222 Enrollment ID: I20230220000080 |
| Provider Name | Tasha Janssen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447808233 PECOS PAC ID: 1850621145 Enrollment ID: I20230417001097 |
| Provider Name | Chante Campbell-nixon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649868738 PECOS PAC ID: 7416361126 Enrollment ID: I20240122003650 |
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