Healthcare Provider Details

I. General information

NPI: 1306906839
Provider Name (Legal Business Name): ELITE MEDICAL TRANSPORT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S SILVER AVE
DEMING NM
88030-5927
US

IV. Provider business mailing address

PO BOX 929
SANTA TERESA NM
88008-0929
US

V. Phone/Fax

Practice location:
  • Phone: 575-544-4241
  • Fax: 915-542-0706
Mailing address:
  • Phone: 915-542-1194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: LEEANN PHILLIPS
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 915-542-1194