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General NPI Number Information
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NPI Number | 1679041263
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Entity Type | Organization
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Legal Business Name | ELITE MEDICAL CARE, LLC
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Dates
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Enumeration Date | 11/13/2018
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Last Update Date | 11/13/2018
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Provider Practice Location Address
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Address Line | 4924 E NETTLETON AVE
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City | JONESBORO
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State | AR
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Zip | 72401-6553
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Country | US
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Telephone | 870-520-5038
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Fax | 833-597-4493
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Provider Business Mailing Address
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Address Line | 11701 INTERSTATE 30 STE 100
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City | LITTLE ROCK
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State | AR
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Zip | 72209-7076
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Country | US
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Telephone | 501-590-6237
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Fax | 855-313-9072
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Authorized Official
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Title or Position | OWNER
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Name | TERRY M RUTLEDGE
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Credential |
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Telephone | 501-590-6237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State |
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