1558810317 NPI number — ELITE ORTHOPEDICS AND SPORTS MEDICINE, PLLC

Table of content: (NPI 1558810317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558810317 NPI number — ELITE ORTHOPEDICS AND SPORTS MEDICINE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELITE ORTHOPEDICS AND SPORTS MEDICINE, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558810317
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 SW 34TH AVE
Provider Second Line Business Mailing Address:
BLDG 500, SUITE 502
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34474-7456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-575-1994
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 SW 34TH AVE
Provider Second Line Business Practice Location Address:
BLDG 500, SUITE 502
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34474-7456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-575-1994
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SAHAJPAL
Authorized Official First Name:
DEENESH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
860-575-1994

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207XX0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110216600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com