Provider Demographics
NPI:1447723358
Name:ELITE TRANSPORTATION-MS, LLC
Entity type:Organization
Organization Name:ELITE TRANSPORTATION-MS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:ELOISE
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-480-7276
Mailing Address - Street 1:PO BOX 202
Mailing Address - Street 2:
Mailing Address - City:SHUBUTA
Mailing Address - State:MS
Mailing Address - Zip Code:39360-0202
Mailing Address - Country:US
Mailing Address - Phone:601-480-7276
Mailing Address - Fax:
Practice Address - Street 1:6320 COUNTY ROAD 610
Practice Address - Street 2:
Practice Address - City:SHUBUTA
Practice Address - State:MS
Practice Address - Zip Code:39360-9329
Practice Address - Country:US
Practice Address - Phone:601-480-7276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)