MEDICARE: ELITE MOBILE HEALTH SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QH0100X	Health Service Clinic/Center
2	293D00000X	Physiological Laboratory
3	163W00000X	Registered Nurse

General Provider Information

NPI Number	:	1407522113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE MOBILE HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	8003 MAURICE RD APT B
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-1640
Country	:	US
Telephone Number	:	501-298-7145
Fax Number	:

Provider Business Practice Location Address
First Line	:	8003 MAURICE RD APT B
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-1640
Country	:	US
Telephone Number	:	501-298-7145
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ASHLEY D JOHNSON
Credential	:	RN
Telephone Number	:	501-298-7145

Provider Enumeration Date	:	08/22/2021
Last Update Date	:	08/22/2021

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