Provider Demographics
NPI:1003988676
Name:ELIXAIR MEDICAL INC.
Entity Type:Organization
Organization Name:ELIXAIR MEDICAL INC.
Other - Org Name:ELIXAIR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ANIS
Authorized Official - Last Name:NOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-354-9247
Mailing Address - Street 1:12035 BURKE ST STE 13
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-8633
Mailing Address - Country:US
Mailing Address - Phone:800-354-9247
Mailing Address - Fax:877-354-9247
Practice Address - Street 1:12035 BURKE ST STE 13
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-8633
Practice Address - Country:US
Practice Address - Phone:800-354-9247
Practice Address - Fax:877-354-9247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55713332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03281FMedicaid
CADME03281FMedicaid