=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598131526
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EL'LUCRE MANAGEMENT CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2015
-----------------------------------------------------
Last Update Date | 08/13/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2211 W PARMER LN UNIT A
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78727-4331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-323-9253
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12407 N MOPAC EXPY #250-342
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78758-2475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-323-9253
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ELIZABETH HUBBELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 512-323-9253
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 1001125
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------