=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891000956
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELITE MEDICAL TRANSPORTATION R&D
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2010
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25173 FARMBROOK RD
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48034-1262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-238-7879
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25173 FARMBROOK RD
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48034-1262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-238-7879
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ROMELL FORD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-238-7879
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------