Provider Demographics
NPI:1396460622
Name:ELITE PAIN SPECIALISTS PA
Entity type:Organization
Organization Name:ELITE PAIN SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ISENALUMHE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:352-515-0025
Mailing Address - Street 1:PO BOX 20494
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-0494
Mailing Address - Country:US
Mailing Address - Phone:727-823-2188
Mailing Address - Fax:
Practice Address - Street 1:17807 HUNTING BOW CIR STE 101
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-5402
Practice Address - Country:US
Practice Address - Phone:813-388-9922
Practice Address - Fax:813-406-4691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty