Provider Demographics
NPI:1740555978
Name:ELITE EMERGENCY TELEMED
Entity type:Organization
Organization Name:ELITE EMERGENCY TELEMED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:DEARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-778-0509
Mailing Address - Street 1:PO BOX 680399
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-0399
Mailing Address - Country:US
Mailing Address - Phone:615-778-0509
Mailing Address - Fax:615-778-0209
Practice Address - Street 1:321 BILLINGSLY CT
Practice Address - Street 2:STE 6
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6444
Practice Address - Country:US
Practice Address - Phone:615-778-0509
Practice Address - Fax:615-778-0209
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELITE EMERGENCY MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3729999Medicare PIN