1528417060 NPI number — ELITE AMBULANCE LLC

Table of content: (NPI 1528417060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528417060 NPI number — ELITE AMBULANCE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELITE AMBULANCE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528417060
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1597
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37088-1597
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-656-4477
Provider Business Mailing Address Fax Number:
615-656-4471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
228 W MAIN ST STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37087-2681
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-656-4777
Provider Business Practice Location Address Fax Number:
615-656-4471
Provider Enumeration Date:
06/06/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HENDERLIGHT
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-656-4477

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)