MEDICARE: ELITECARE MEDICAL TRANSPORT LLC

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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1598611980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITECARE MEDICAL TRANSPORT LLC

Provider Business Mailing Address
First Line	:	158 SAINT CROIX DR
Second Line	:
City	:	WATERLOO
State	:	IA
Zip	:	50703-1035
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	158 SAINT CROIX DR
Second Line	:
City	:	WATERLOO
State	:	IA
Zip	:	50703-1035
Country	:	US
Telephone Number	:	347-423-3499
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SENORIA SHANTE WALLLICAN-NESBIT
Credential	:
Telephone Number	:	347-423-3499

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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