Provider Demographics
NPI:1699522326
Name:ELITE EQUIPMENT AND SUPPLIES LLC
Entity type:Organization
Organization Name:ELITE EQUIPMENT AND SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KHALIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFIQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-379-8074
Mailing Address - Street 1:314 E HIGHLAND MALL BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-3701
Mailing Address - Country:US
Mailing Address - Phone:512-379-8074
Mailing Address - Fax:512-379-8074
Practice Address - Street 1:314 E HIGHLAND MALL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-3701
Practice Address - Country:US
Practice Address - Phone:512-379-8074
Practice Address - Fax:512-379-8074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies