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General NPI Number Information
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NPI Number | 1093534240
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Entity Type | Organization
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Legal Business Name | ELITE SUPPLY & SERVICES, LLC
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Dates
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Enumeration Date | 10/05/2024
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Last Update Date | 10/05/2024
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Provider Practice Location Address
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Address Line | 1100 US HWY 27 STE F UNIT 135758
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City | CLERMONT
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State | FL
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Zip | 34714
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Country | US
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Telephone | 843-251-8721
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 US HWY 27 STE F UNIT 135758
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City | CLERMONT
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State | FL
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Zip | 34714
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Country | US
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Telephone | 843-251-8721
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. THOMAS EARL MARTIN III
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Credential | PHD
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Telephone | 843-251-8721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 342000000X
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Taxonomy Name | Transportation Network Company
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License Number |
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License Number State |
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