Provider Demographics
NPI:1659696276
Name:ELITE MEDICAL CONNECTIONS, LLC
Entity Type:Organization
Organization Name:ELITE MEDICAL CONNECTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RRT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RUTLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:870-378-6311
Mailing Address - Street 1:1023 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:AR
Mailing Address - Zip Code:72002-1749
Mailing Address - Country:US
Mailing Address - Phone:870-378-6311
Mailing Address - Fax:501-407-0585
Practice Address - Street 1:1023 SKYLINE DRIVE
Practice Address - Street 2:
Practice Address - City:ALEXANDER
Practice Address - State:AR
Practice Address - Zip Code:72002
Practice Address - Country:US
Practice Address - Phone:870-378-6311
Practice Address - Fax:501-407-0585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization