Provider Demographics
NPI:1518089861
Name:ELITE MEDICAL TECHNOLOGIES, LLC
Entity Type:Organization
Organization Name:ELITE MEDICAL TECHNOLOGIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:P
Authorized Official - Last Name:IMIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-234-1100
Mailing Address - Street 1:9152 PINTO CANYON WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-7109
Mailing Address - Country:US
Mailing Address - Phone:209-234-1100
Mailing Address - Fax:209-234-7600
Practice Address - Street 1:9152 PINTO CANYON WAY
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-7109
Practice Address - Country:US
Practice Address - Phone:209-234-1100
Practice Address - Fax:209-234-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies