Healthcare Provider Details

I. General information

NPI: 1154895878
Provider Name (Legal Business Name): ELITE CLINICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 NW FEDERAL HWY
JENSEN BEACH FL
34957-3676
US

IV. Provider business mailing address

3601 NW FEDERAL HWY
JENSEN BEACH FL
34957-3676
US

V. Phone/Fax

Practice location:
  • Phone: 772-301-9369
  • Fax: 772-209-4200
Mailing address:
  • Phone: 772-301-9369
  • Fax: 772-209-4200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON WATT
Title or Position: CEO
Credential: MD
Phone: 772-208-3057