Provider Demographics
NPI:1225760820
Name:ELITE MEDICAL TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:ELITE MEDICAL TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ZSHANEKA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-530-8045
Mailing Address - Street 1:3186 BARLAND RD
Mailing Address - Street 2:
Mailing Address - City:PATTISON
Mailing Address - State:MS
Mailing Address - Zip Code:39144-9439
Mailing Address - Country:US
Mailing Address - Phone:601-530-8045
Mailing Address - Fax:
Practice Address - Street 1:3186 BARLAND RD
Practice Address - Street 2:
Practice Address - City:PATTISON
Practice Address - State:MS
Practice Address - Zip Code:39144-9439
Practice Address - Country:US
Practice Address - Phone:601-530-8045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)