| Elite Iom Llc | |
|
2501 Chatham Rd Ste R Springfield IL 62704-4188 | |
| (866) 374-6628 | |
| (866) 951-1120 |
| Full Name | Elite Iom Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Clinical Neurophysiology |
| Location | 2501 Chatham Rd Ste R, Springfield, Illinois |
| Authorized Official Name and Position | Jenna Bledsoe (CHEIF OPERATING OFFICER) |
| Authorized Official Contact | 8663746628 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Iom Llc 2501 Chatham Rd Ste R Springfield IL 62704-4188 Ph: (866) 374-6628 | Elite Iom Llc 2501 Chatham Rd Ste R Springfield IL 62704-4188 Ph: (866) 374-6628 |
| NPI Number | 1952196586 |
|---|---|
| Provider Enumeration Date | 04/14/2025 |
| Last Update Date | 04/14/2025 |
| Certification Date | 04/14/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952196586 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0600X | Psychiatry & Neurology - Clinical Neurophysiology | (* (Not Available)) | Primary |
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