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General NPI Number Information
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NPI Number | 1881986396
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Entity Type | Organization
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Legal Business Name | ELITE HEALTHCARE GROUP PC
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Dates
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Enumeration Date | 05/03/2011
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | 1335 FLOWERING DOGWOOD LN
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City | DYERSBURG
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State | TN
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Zip | 38024-2890
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Country | US
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Telephone | 731-286-2467
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Fax | 731-286-1178
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Provider Business Mailing Address
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Address Line | 1335 FLOWERING DOGWOOD LN
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City | DYERSBURG
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State | TN
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Zip | 38024-2890
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Country | US
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Telephone | 731-286-2467
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Fax | 731-286-1178
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. APRIL BEASLEY
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Credential |
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Telephone | 731-286-2467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | TN
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