Provider Demographics
NPI:1467013532
Name:ELITE ORTHOPEDIC AND SPINE CENTERS, LLC
Entity Type:Organization
Organization Name:ELITE ORTHOPEDIC AND SPINE CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEATHERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-245-8397
Mailing Address - Street 1:8925 SE BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-5312
Mailing Address - Country:US
Mailing Address - Phone:772-245-8397
Mailing Address - Fax:
Practice Address - Street 1:2090 SARNO RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3077
Practice Address - Country:US
Practice Address - Phone:321-608-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty