Provider Demographics
NPI:1679041263
Name:ELITE MEDICAL CARE, LLC
Entity Type:Organization
Organization Name:ELITE MEDICAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUTLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-590-6237
Mailing Address - Street 1:11701 INTERSTATE 30 STE 100
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-7076
Mailing Address - Country:US
Mailing Address - Phone:501-590-6237
Mailing Address - Fax:855-313-9072
Practice Address - Street 1:4924 E NETTLETON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6553
Practice Address - Country:US
Practice Address - Phone:870-520-5038
Practice Address - Fax:833-597-4493
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELITE MEDICAL CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies