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General NPI Number Information
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NPI Number | 1497322325
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Entity Type | Organization
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Legal Business Name | NORTHEAST ELITE MEDICAL CLINIC, LLC
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Dates
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Enumeration Date | 06/09/2021
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Last Update Date | 06/09/2021
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Provider Practice Location Address
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Address Line | 136-4 FORUM DR 1018
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City | COLUMBIA
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State | SC
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Zip | 29229
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Country | US
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Telephone | 803-836-8679
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Fax | 803-800-2007
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Provider Business Mailing Address
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Address Line | 136-4 FORUM DR 1018
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City | COLUMBIA
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State | SC
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Zip | 29229
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Country | US
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Telephone | 803-836-8679
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Fax | 803-800-2007
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Authorized Official
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Title or Position | CEO
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Name | MRS. PAULETTE RUMPH
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Credential | FNP
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Telephone | 803-836-8679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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