Provider Demographics
NPI:1659374858
Name:ELJ INC
Entity Type:Organization
Organization Name:ELJ INC
Other - Org Name:MILLENNIUM / COMPASS MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATRISHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JETTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-739-8539
Mailing Address - Street 1:1500 CLARKSVILLE ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-6076
Mailing Address - Country:US
Mailing Address - Phone:903-739-8539
Mailing Address - Fax:903-739-8206
Practice Address - Street 1:1500 CLARKSVILLE ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-6076
Practice Address - Country:US
Practice Address - Phone:903-739-8539
Practice Address - Fax:903-739-8206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0056496332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147981801Medicaid
TX147982601Medicaid
TX4314140001Medicare NSC