Healthcare Provider Details

I. General information

NPI: 1326920117
Provider Name (Legal Business Name): ELITE NEUROSPINE & VASCULAR INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 ROSS CLARK CIR STE 704
DOTHAN AL
36301-3030
US

IV. Provider business mailing address

1118 ROSS CLARK CIR STE 704
DOTHAN AL
36301-3030
US

V. Phone/Fax

Practice location:
  • Phone: 334-824-3098
  • Fax: 334-761-2449
Mailing address:
  • Phone: 334-824-3098
  • Fax: 334-761-2449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSHUA STERLING BENTLEY
Title or Position: OWNER
Credential: D.O.
Phone: 334-824-3098