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General NPI Number Information
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NPI Number | 1871946236
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Entity Type | Organization
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Legal Business Name | ELITE HEALTHCARE AND WELLNESS GROUP, INC
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Dates
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Enumeration Date | 07/20/2016
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Last Update Date | 07/20/2016
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Provider Practice Location Address
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Address Line | 2400 VANDERBILT BEACH RD SUITE 106
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City | NAPLES
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State | FL
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Zip | 34109-2771
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Country | US
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Telephone | 239-631-6529
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Fax | 239-631-6720
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Provider Business Mailing Address
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Address Line | 2430 VANDERBILT BEACH RD SUITE 108-345
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City | NAPLES
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State | FL
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Zip | 34109-2654
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Country | US
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Telephone | 239-631-6529
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Fax | 239-631-6720
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JT DEWITT JR.
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Credential | D.O.
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Telephone | 239-631-6529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS13806
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License Number State | FL
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