Healthcare Provider Details

I. General information

NPI: 1093534240
Provider Name (Legal Business Name): ELITE SUPPLY & SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2024
Last Update Date: 10/05/2024
Certification Date: 10/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 US HWY 27 STE F UNIT 135758
CLERMONT FL
34714
US

IV. Provider business mailing address

1100 US HWY 27 STE F UNIT 135758
CLERMONT FL
34714
US

V. Phone/Fax

Practice location:
  • Phone: 843-251-8721
  • Fax:
Mailing address:
  • Phone: 843-251-8721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS EARL MARTIN III
Title or Position: OWNER
Credential: PHD
Phone: 843-251-8721