Healthcare Provider Details

I. General information

NPI: 1295079465
Provider Name (Legal Business Name): ELITE MEDICAL & MOBILITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2012
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 ELM ST
FRISCO TX
75034-4234
US

IV. Provider business mailing address

11812 COUNTY ROAD 1104
CELINA TX
75009-2776
US

V. Phone/Fax

Practice location:
  • Phone: 214-872-1880
  • Fax: 214-380-9393
Mailing address:
  • Phone: 214-697-4851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: PAMELA ETZEL
Title or Position: OWNER
Credential:
Phone: 214-872-1880