Healthcare Provider Details

I. General information

NPI: 1386955839
Provider Name (Legal Business Name): ELITE MEDICAL SUPPLIES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 FAULKNER DR
LINCOLN NE
68516-4738
US

IV. Provider business mailing address

3901 FAULKNER DR
LINCOLN NE
68516-4738
US

V. Phone/Fax

Practice location:
  • Phone: 402-464-2422
  • Fax: 402-464-2922
Mailing address:
  • Phone: 402-464-2422
  • Fax: 402-464-2922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberNOT OBTAINED YET
License Number StateNE

VIII. Authorized Official

Name: MRS. JENNIFER GIBBONS
Title or Position: SECRETARY/OWNER
Credential: RN
Phone: 402-464-2422