Healthcare Provider Details

I. General information

NPI: 1346015526
Provider Name (Legal Business Name): ELITE MEDICAL INNOVATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 05/07/2024
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S 4TH ST STE 550
SAINT LOUIS MO
63102-1897
US

IV. Provider business mailing address

100 S 4TH ST STE 550
SAINT LOUIS MO
63102-1897
US

V. Phone/Fax

Practice location:
  • Phone: 314-710-6504
  • Fax:
Mailing address:
  • Phone: 314-710-6504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. TAMEKA ELAINE HOLLINS
Title or Position: CEO
Credential:
Phone: 314-710-6504