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ELITE SPINE LLC NPI 1639698269


NPI Information

NPI: 1639698269
Provider Name: ELITE SPINE LLC
Classification: Clinic/Center - 261QM2500X
Entity Type: Organization

Specialization: Medical Specialty

Address:
800 DUNLAWTON AVE STE 103
PORT ORANGE, FL
ZIP 32127
Phone: (386) 265-0102
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ELITE SPINE LLC is a medical specialty clinic center in Port Orange, FL. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). ELITE SPINE LLC NPI is 1639698269. The provider is registered as an organization entity type.

The provider's business location address is:

800 DUNLAWTON AVE STE 103
PORT ORANGE, FL
ZIP 32127-249
Phone: (386) 265-0102
Fax: (386) 401-2316

The provider's authorized official is Rachel Nakayama .
The authorized official title is Owner and has the following contact phone number (386) 872-2929.

The enumeration date for this NPI number is 9/14/2017 and was last updated on 10/4/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM2500XClinic/CenterMedical SpecialtyCH12049FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11295271344MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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