Healthcare Provider Details

I. General information

NPI: 1710294368
Provider Name (Legal Business Name): ELITE MEDICAL TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 W 190TH ST SUITE B-1
MOKENA IL
60448-5604
US

IV. Provider business mailing address

9850 W 190TH ST SUITE B-1
MOKENA IL
60448-5604
US

V. Phone/Fax

Practice location:
  • Phone: 708-478-8880
  • Fax: 708-478-8653
Mailing address:
  • Phone: 708-478-8880
  • Fax: 708-478-8653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number8085
License Number StateIL

VIII. Authorized Official

Name: MRS. CHRISTI I VOGRIG
Title or Position: DIRECTOR OF PATIENT ACCOUNTS
Credential:
Phone: 708-478-8880