MEDICARE: ELITE MEDICINE 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1689322588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE MEDICINE LLC

Provider Business Mailing Address
First Line	:	8240 BECKETT PARK DR STE A
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-9313
Country	:	US
Telephone Number	:	513-860-2888
Fax Number	:	513-860-9507

Provider Business Practice Location Address
First Line	:	8240 BECKETT PARK DR STE A
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-9313
Country	:	US
Telephone Number	:	513-860-2888
Fax Number	:	513-860-9507

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	SHELLI RIDGE
Credential	:	DO
Telephone Number	:	419-366-8494

Provider Enumeration Date	:	03/10/2022
Last Update Date	:	03/10/2022

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Directions to “ELITE MEDICINE LLC ” Practice Location

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