Provider Demographics
NPI:1801071808
Name:ELITE MEDICAL SUPPLIES, INC.
Entity type:Organization
Organization Name:ELITE MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARRETT-GOLDHIRSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-224-8491
Mailing Address - Street 1:835 S WOLCOTT AVE
Mailing Address - Street 2:M/C 844
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3748
Mailing Address - Country:US
Mailing Address - Phone:312-224-8491
Mailing Address - Fax:312-277-9575
Practice Address - Street 1:835 S WOLCOTT AVE
Practice Address - Street 2:M/C 844
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3748
Practice Address - Country:US
Practice Address - Phone:312-224-8491
Practice Address - Fax:312-277-9575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid