Provider Demographics
NPI:1073726386
Name:ELITE AMBULATORY SERVICES LLC
Entity Type:Organization
Organization Name:ELITE AMBULATORY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:I
Authorized Official - Last Name:TRIBIT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:941-544-7512
Mailing Address - Street 1:1690 SWEETLAND ST
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275-1634
Mailing Address - Country:US
Mailing Address - Phone:941-544-7512
Mailing Address - Fax:
Practice Address - Street 1:1690 SWEETLAND ST
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-1634
Practice Address - Country:US
Practice Address - Phone:941-544-7512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 19775261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE7455Medicare ID - Type Unspecified