Healthcare Provider Details

I. General information

NPI: 1265901110
Provider Name (Legal Business Name): ELITE CARE MEDICAL SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2018
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 UNIVERSITY BLVD S STE 109
JACKSONVILLE FL
32216-2737
US

IV. Provider business mailing address

3100 UNIVERSITY BLVD S STE 109
JACKSONVILLE FL
32216-2737
US

V. Phone/Fax

Practice location:
  • Phone: 904-504-0601
  • Fax: 866-667-9488
Mailing address:
  • Phone: 904-504-0601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ELIJAH WALKER
Title or Position: OWNER
Credential:
Phone: 904-504-0601