Provider Demographics
NPI:1083075352
Name:ELITE PAIN SPECIALISTS PA
Entity Type:Organization
Organization Name:ELITE PAIN SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ISENALUMHE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:352-515-0025
Mailing Address - Street 1:PO BOX 20494
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-0494
Mailing Address - Country:US
Mailing Address - Phone:352-515-0025
Mailing Address - Fax:352-515-0174
Practice Address - Street 1:13141 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5016
Practice Address - Country:US
Practice Address - Phone:352-515-0025
Practice Address - Fax:352-515-0174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207LP2900X
FLME123669261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIH692ZMedicare PIN
FLIH692YMedicare PIN
FLIH692XMedicare PIN