Provider Demographics
NPI:1568928463
Name:ELITE MEDICAL TRANSIT PROFESSIONAL LLC
Entity Type:Organization
Organization Name:ELITE MEDICAL TRANSIT PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-779-7113
Mailing Address - Street 1:4209 GAULT PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-8006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4209 GAULT PL NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-8006
Practice Address - Country:US
Practice Address - Phone:240-779-7113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-15
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)