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General NPI Number Information
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NPI Number | 1952196586
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Entity Type | Organization
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Legal Business Name | ELITE IOM LLC
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Dates
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Enumeration Date | 04/14/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 2501 CHATHAM RD STE R
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4188
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Country | US
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Telephone | 866-374-6628
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Fax | 866-951-1120
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Provider Business Mailing Address
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Address Line | 2501 CHATHAM RD STE R
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4188
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Country | US
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Telephone | 866-374-6628
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Fax | 866-951-1120
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Authorized Official
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Title or Position | CHEIF OPERATING OFFICER
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Name | JENNA BLEDSOE
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Credential |
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Telephone | 866-374-6628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number |
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License Number State |
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