NPIMap

Organization Active NPI

El-Elyon Medical Supply, LLC

  • Durable Medical Equipment & Medical Supplies
  • Grand Prairie, TX
National Provider Identifier
1710977996
Registry record updated Mar 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
0083793 Issued in TX
Legal business name
EL-ELYON MEDICAL SUPPLY, LLC
Doing business as
El-Elyon Medical Supply, LLC
Practice address
2307 Oak LN
Ste # 106
Grand Prairie, TX 75051-4885
Phone
(972) 266-2030
Fax
(972) 266-0355
NPI assigned
Oct 27, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Beatrice FeyisetanNPI 1972205763
Title
Owner
Phone
(972) 266-2030

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 0083793 TX Primary

Addresses

Primary practice location

2307 Oak LN
Ste # 106
Grand Prairie, TX 75051-4885

Mailing address

2307 Oak LN
Ste # 106
Grand Prairie, TX 75051-4885
Phone (972) 266-2030

Other identifiers 2

IdentifierTypeStateIssuer
169961301MedicaidTX
169961302MedicaidTX

Other names 1

  • El-Elyon Medical Supply, LLC Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301356800000",
    "number": "1710977996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2307 OAK LN",
            "address_2": "STE # 106",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750514885",
            "telephone_number": "972-266-2030",
            "fax_number": "972-266-0355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2307 OAK LN",
            "address_2": "STE # 106",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750514885",
            "telephone_number": "972-266-2030",
            "fax_number": "972-266-0355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL-ELYON MEDICAL SUPPLY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-27",
        "last_updated": "2011-03-29",
        "status": "A",
        "authorized_official_last_name": "FEYISETAN",
        "authorized_official_first_name": "BEATRICE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-266-2030",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TX",
            "license": "0083793",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "169961301",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "169961302",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "El-Elyon Medical Supply, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Prairie, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.