{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "ELITE PAIN SPECIALISTS PA",
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"MiddleName": null,
"NamePrefix": null,
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"FirstLineMailingAddress": "PO BOX 20494",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TAMPA",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33622-0494",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "352-515-0025",
"MailingAddressFaxNumber": "352-515-0174",
"FirstLinePracticeLocationAddress": "13141 SPRING HILL DR",
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"PracticeLocationAddressCityName": "SPRING HILL",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34609-5016",
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"PracticeLocationAddressTelephoneNumber": "352-515-0025",
"PracticeLocationAddressFaxNumber": "813-406-4691",
"EnumerationDate": "03/15/2016",
"LastUpdateDate": "08/08/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ISENALUMHE",
"AuthorizedOfficialFirstName": "ANTHONY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "MD",
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"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QP3300X",
"TaxonomyName": "Pain Clinic/Center",
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"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207LP2900X",
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}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}