Provider Demographics
NPI:1376974097
Name:ELITE ORTHOPEDIC SPECIALISTS, LLC
Entity Type:Organization
Organization Name:ELITE ORTHOPEDIC SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:VANDERHOOF
Authorized Official - Suffix:
Authorized Official - Credentials:ACHE
Authorized Official - Phone:813-505-0790
Mailing Address - Street 1:6918 GUNN HWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-3853
Mailing Address - Country:US
Mailing Address - Phone:815-852-2500
Mailing Address - Fax:813-852-2602
Practice Address - Street 1:6918 GUNN HWY
Practice Address - Street 2:SUITE E
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-3853
Practice Address - Country:US
Practice Address - Phone:815-852-2500
Practice Address - Fax:813-852-2602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical