Healthcare Provider Details

I. General information

NPI: 1679041263
Provider Name (Legal Business Name): ELITE MEDICAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4924 E NETTLETON AVE
JONESBORO AR
72401-6553
US

IV. Provider business mailing address

11701 INTERSTATE 30 STE 100
LITTLE ROCK AR
72209-7076
US

V. Phone/Fax

Practice location:
  • Phone: 870-520-5038
  • Fax: 833-597-4493
Mailing address:
  • Phone: 501-590-6237
  • Fax: 855-313-9072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: TERRY M RUTLEDGE
Title or Position: OWNER
Credential:
Phone: 501-590-6237