Healthcare Provider Details

I. General information

NPI: 1407402381
Provider Name (Legal Business Name): ELITE MEDICAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 WOODLAND RD STE 3
BATESVILLE MS
38606-8483
US

IV. Provider business mailing address

11701 I 30 STE 100
LITTLE ROCK AR
72209-7076
US

V. Phone/Fax

Practice location:
  • Phone: 501-317-8286
  • Fax: 855-313-9072
Mailing address:
  • Phone: 501-590-6237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TERRY M RUTLEDGE
Title or Position: OWNER
Credential:
Phone: 501-590-6237