Elite Medical Providers LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

ELITE MEDICAL PROVIDERS LLC

Practice address

1701 SE Hillmoor Dr # 17
Port Saint Lucie, FL 34952-7552

Phone

(772) 207-0697

NPI assigned

Sep 10, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Francine Costello

Title

Accountant

Phone

(772) 528-9991

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1725926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725926400000",
    "number": "1003642877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 SE HILLMOOR DR # 17",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349527552",
            "telephone_number": "772-207-0697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 SE HILLMOOR DR # 17",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349527552",
            "telephone_number": "772-207-0697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE MEDICAL PROVIDERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-10",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A",
        "authorized_official_last_name": "COSTELLO",
        "authorized_official_first_name": "FRANCINE",
        "authorized_official_title_or_position": "ACCOUNTANT",
        "authorized_official_telephone_number": "772-528-9991"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eduardo Borges, MD, PA
• Shannon Margaret Edwards
• Katie Anne Morris Eisnaugle, FNP-C, PMHNP-BC
• Austin Allen Ekonomou
• Elite Health and Wellness Center LLC
• Kerry Ann Ellington Robinson
• Kimberly Ellis, D.O.
• Kimberly M Ellis, MS, MPH, RD, LD/N
• Kimberly Tonine Ellis, LCSW
• Elyon World Assisted Living LLC

• Family Medicine Physician in Port Saint Lucie, FL
• Providers in Port Saint Lucie, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.