Provider Demographics
NPI:1982847273
Name:ELITE DME INC
Entity Type:Organization
Organization Name:ELITE DME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-804-9318
Mailing Address - Street 1:12385 SW 129TH CT
Mailing Address - Street 2:#109
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6407
Mailing Address - Country:US
Mailing Address - Phone:305-225-5770
Mailing Address - Fax:
Practice Address - Street 1:12385 SW 129TH CT
Practice Address - Street 2:#109
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6407
Practice Address - Country:US
Practice Address - Phone:305-225-5770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIN PROCESS OF AHCA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies