MEDICARE: ELITE MONITORING PROFESSIONAL

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	246Z00000X	Other Specialist/Technologist

General Provider Information

NPI Number	:	1346482205
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE MONITORING PROFESSIONAL

Provider Business Mailing Address
First Line	:	8500 PRAIRIE DAWN DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76131-5350
Country	:	US
Telephone Number	:	817-975-8226
Fax Number	:	817-306-5294

Provider Business Practice Location Address
First Line	:	8500 PRAIRIE DAWN DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76131-5350
Country	:	US
Telephone Number	:	817-975-8226
Fax Number	:	817-306-5294

Authorized Official
Title or Position	:	MANAGEMENT MEMBER
Name	:	MR. BRIAN KEITH TAYLOR
Credential	:
Telephone Number	:	817-975-8226

Provider Enumeration Date	:	03/24/2009
Last Update Date	:	03/24/2009

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Directions to “ELITE MONITORING PROFESSIONAL ” Practice Location

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