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

Last updated

Jun 9, 2021By the provider in NPPES

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, FNPNPI 1356821904

Title

Ceo

Phone

(803) 836-8679

Specialties & licenses 3

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Paulette O'Neal Rumph

  • Family Nurse Practitioner
  • Columbia, SC
  • NPI 1356821904
  Authorized official Same address or phone

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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• Northeast Dermatology, PA
• Northeast Family Dentistry
• Northeast Medical Specialists
• Northeast Oral & Maxillofacial
• Northeast Oral & Maxillofacial Surgery Center
• Northeast Smile Center

• 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.