Basic Information
| Provider Information | |||||||||
| NPI: | 1083075352 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELITE PAIN SPECIALISTS PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 20494 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336220494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525150025 | ||||||||
| FaxNumber: | 3525150174 | ||||||||
| Practice Location | |||||||||
| Address1: | 13141 SPRING HILL DR | ||||||||
| Address2: | |||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346095016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525150025 | ||||||||
| FaxNumber: | 3525150174 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2016 | ||||||||
| LastUpdateDate: | 07/27/2021 | ||||||||
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| AuthorizedOfficialLastName: | ISENALUMHE | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3525150025 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 07/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP3300X | ME123669 | FL | N | Ambulatory Health Care Facilities | Clinic/Center | Pain | 207LP2900X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.