Healthcare Provider Details

I. General information

NPI: 1972759801
Provider Name (Legal Business Name): ELITE MEDICAL PRODUCTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

588 OLDS ST.
JONESVILLE MI
49250-9975
US

IV. Provider business mailing address

588 OLDS ST.
JONESVILLE MI
49250-9975
US

V. Phone/Fax

Practice location:
  • Phone: 517-849-7259
  • Fax: 866-929-8390
Mailing address:
  • Phone: 517-849-7259
  • Fax: 866-929-8390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6208460001
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number6208460001
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number6208460001
License Number StateMI

VIII. Authorized Official

Name: MR. JASON TRAVIS WALTERS
Title or Position: PRESIDENT / CEO
Credential:
Phone: 517-398-0425