Provider Demographics
NPI:1952555088
Name:ELITE MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:ELITE MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:
Authorized Official - Last Name:LETANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:340-779-8116
Mailing Address - Street 1:1003 ESTATE ROSS STE 6
Mailing Address - Street 2:BARBEL PLAZA
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-6725
Mailing Address - Country:US
Mailing Address - Phone:340-779-8116
Mailing Address - Fax:340-779-8116
Practice Address - Street 1:1003 ESTATE ROSS STE 6
Practice Address - Street 2:BARBEL PLAZA
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-6725
Practice Address - Country:US
Practice Address - Phone:340-779-8116
Practice Address - Fax:340-779-8116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1-2045977-2008332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies