Provider Demographics
NPI:1952679052
Name:ELITE MEDICAL EQUIPMENT AND SUPPLIES, L.L.C.
Entity Type:Organization
Organization Name:ELITE MEDICAL EQUIPMENT AND SUPPLIES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:REMALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-468-1041
Mailing Address - Street 1:407 NE 76TH TER
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-1708
Mailing Address - Country:US
Mailing Address - Phone:816-468-1041
Mailing Address - Fax:816-468-1583
Practice Address - Street 1:407 NE 76TH TER
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-1708
Practice Address - Country:US
Practice Address - Phone:816-468-1041
Practice Address - Fax:816-468-1583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1175709OtherUSA MANAGED CARE ORGANIZATION
MO47725017OtherBLUE CROSS BLUE SHIELD KC
MO620001331Medicaid
MO620001331Medicaid