Provider Demographics
NPI:1962048629
Name:ELITE MEDICAL SUPPLY, LLC
Entity type:Organization
Organization Name:ELITE MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MULE'
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-294-1139
Mailing Address - Street 1:6252 S CONGRESS AVE STE J2
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-2352
Mailing Address - Country:US
Mailing Address - Phone:561-469-2090
Mailing Address - Fax:866-488-5553
Practice Address - Street 1:6252 S CONGRESS AVE STE J2
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-2352
Practice Address - Country:US
Practice Address - Phone:561-469-2090
Practice Address - Fax:866-488-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies