=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902119647
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | G ELLIOTT HOULDINGS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2010
-----------------------------------------------------
Last Update Date | 07/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5408 1ST ST
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39307-6663
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-527-6316
-----------------------------------------------------
Fax | 601-553-0730
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5408 1ST ST
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39307-6663
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-527-6316
-----------------------------------------------------
Fax | 601-553-0730
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. GREGORY ELLIOTT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 601-527-6316
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 08554/11.1
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------