Provider Demographics
NPI:1093534240
Name:ELITE SUPPLY & SERVICES, LLC
Entity type:Organization
Organization Name:ELITE SUPPLY & SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:III
Authorized Official - Credentials:PHD
Authorized Official - Phone:843-251-8721
Mailing Address - Street 1:1100 US HWY 27 STE F
Mailing Address - Street 2:UNIT 135758
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714
Mailing Address - Country:US
Mailing Address - Phone:843-251-8721
Mailing Address - Fax:
Practice Address - Street 1:1100 US HWY 27 STE F
Practice Address - Street 2:UNIT 135758
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714
Practice Address - Country:US
Practice Address - Phone:843-251-8721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-05
Last Update Date:2024-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company
No347C00000XTransportation ServicesPrivate Vehicle