MEDICARE: ELITE ADVANTAGE DM, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1457465148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE ADVANTAGE DM, LLC

Provider Business Mailing Address
First Line	:	4480 BLALOCK RD STE 500
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77041-9119
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4480 BLALOCK RD STE 500
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77041-9119
Country	:	US
Telephone Number	:	713-462-0216
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LUCIA S. DAVIS
Credential	:	RN
Telephone Number	:	713-462-0216

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	08/22/2020

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Directions to “ELITE ADVANTAGE DM, LLC ” Practice Location

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