MEDICARE: ELITE MEDICAL SUPPLY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215933171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 19635
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73144-0635
Country	:	US
Telephone Number	:	405-632-2755
Fax Number	:	405-632-5244

Provider Business Practice Location Address
First Line	:	7217 S WESTERN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-2005
Country	:	US
Telephone Number	:	405-632-2755
Fax Number	:	405-632-5244

Authorized Official
Title or Position	:	CEO
Name	:	MRS. SHEMIN ABOO
Credential	:
Telephone Number	:	405-632-2755

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	09/08/2008

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