Northeast Elite Medical Clinic, LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

NORTHEAST ELITE MEDICAL CLINIC, LLC

Practice address

136-4 Forum Dr
1018
Columbia, SC 29229

Phone

(803) 836-8679

Fax

(803) 800-2007

NPI assigned

Jun 9, 2021

Organization subpart

No

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

Authorized official

Name

Mrs. Paulette Rumph, FNP

Title

Ceo

Phone

(803) 836-8679

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1623196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623196800000",
    "number": "1497322325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136-4 FORUM DR",
            "address_2": "1018",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29229",
            "telephone_number": "803-836-8679",
            "fax_number": "803-800-2007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136-4 FORUM DR",
            "address_2": "1018",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29229",
            "telephone_number": "803-836-8679",
            "fax_number": "803-800-2007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST ELITE MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-09",
        "last_updated": "2021-06-09",
        "certification_date": "2021-05-21",
        "status": "A",
        "authorized_official_last_name": "RUMPH",
        "authorized_official_first_name": "PAULETTE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "803-836-8679",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Columbia, SC
• Providers in Columbia, SC by specialty
• Family Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2021; 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.