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General NPI Number Information
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NPI Number | 1710268156
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Entity Type | Organization
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Legal Business Name | ELITE ADVANCED EMS INC
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Dates
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Enumeration Date | 08/30/2011
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Last Update Date | 08/14/2012
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Provider Practice Location Address
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Address Line | 4434 BLUEBONNET DR SUITE 122
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City | STAFFORD
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State | TX
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Zip | 77477-2904
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Country | US
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Telephone | 281-818-4893
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Fax |
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Provider Business Mailing Address
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Address Line | 4434 BLUEBONNET DR SUITE 122
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City | STAFFORD
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State | TX
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Zip | 77477-2904
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Country | US
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Telephone | 281-818-4893
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARVIS ANETOR
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Credential |
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Telephone | 281-818-4893
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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 | 1000675
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License Number State | TX
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