Provider Demographics
NPI:1295079465
Name:ELITE MEDICAL & MOBILITY, LLC
Entity type:Organization
Organization Name:ELITE MEDICAL & MOBILITY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-872-1880
Mailing Address - Street 1:11812 COUNTY ROAD 1104
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-2776
Mailing Address - Country:US
Mailing Address - Phone:214-697-4851
Mailing Address - Fax:
Practice Address - Street 1:7111 ELM ST
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4234
Practice Address - Country:US
Practice Address - Phone:214-872-1880
Practice Address - Fax:214-380-9393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-12
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX318679301Medicaid
TX6730650001Medicare NSC