Provider Demographics
NPI:1043726896
Name:ELITE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:ELITE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ARRON
Authorized Official - Last Name:SURFACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-987-0297
Mailing Address - Street 1:1166 GREENWAY DR STE A3
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-2919
Mailing Address - Country:US
Mailing Address - Phone:573-987-0297
Mailing Address - Fax:573-987-0298
Practice Address - Street 1:1166 GREENWAY DR STE A3
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-2919
Practice Address - Country:US
Practice Address - Phone:573-987-0297
Practice Address - Fax:573-987-0298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies