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General NPI Number Information
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NPI Number | 1528417060
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Entity Type | Organization
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Legal Business Name | ELITE AMBULANCE LLC
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Dates
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Enumeration Date | 06/06/2016
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 228 W MAIN ST STE D
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City | LEBANON
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State | TN
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Zip | 37087-2681
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Country | US
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Telephone | 615-656-4777
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Fax | 615-656-4471
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Provider Business Mailing Address
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Address Line | PO BOX 1597
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City | LEBANON
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State | TN
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Zip | 37088-1597
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Country | US
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Telephone | 615-656-4477
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Fax | 615-656-4471
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID T HENDERLIGHT
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Credential |
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Telephone | 615-656-4477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State | TN
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