Provider Demographics
NPI:1255538062
Name:ELITE RESPIRATORY AND MEDICAL SUPPLIES
Entity type:Organization
Organization Name:ELITE RESPIRATORY AND MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCALLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-835-7540
Mailing Address - Street 1:6902 COMMERCE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-6860
Mailing Address - Country:US
Mailing Address - Phone:727-835-7540
Mailing Address - Fax:727-835-7555
Practice Address - Street 1:6902 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-6860
Practice Address - Country:US
Practice Address - Phone:727-835-7540
Practice Address - Fax:727-835-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL322359332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3891580001Medicare ID - Type Unspecified