Provider Demographics
NPI:1205235025
Name:ELITE MEDICAL TRANSPORTATION
Entity type:Organization
Organization Name:ELITE MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:SWAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-804-1503
Mailing Address - Street 1:425 W SCHROCK RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8918
Mailing Address - Country:US
Mailing Address - Phone:614-804-1503
Mailing Address - Fax:
Practice Address - Street 1:425 W SCHROCK RD
Practice Address - Street 2:SUITE 204
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8918
Practice Address - Country:US
Practice Address - Phone:614-804-1503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTT434958343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0098706Medicaid