MEDICARE: ELJ 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	0056496	TX

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659374858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELJ INC

Provider Business Mailing Address
First Line	:	1500 CLARKSVILLE ST
Second Line	:
City	:	PARIS
State	:	TX
Zip	:	75460-6076
Country	:	US
Telephone Number	:	903-739-8539
Fax Number	:	903-739-8206

Provider Business Practice Location Address
First Line	:	1500 CLARKSVILLE ST
Second Line	:
City	:	PARIS
State	:	TX
Zip	:	75460-6076
Country	:	US
Telephone Number	:	903-739-8539
Fax Number	:	903-739-8206

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MRS. LATRISHIA JETTON
Credential	:
Telephone Number	:	903-739-8539

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	12/22/2009

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Directions to “ELJ INC ” Practice Location

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