Elite Multi Specialty Clinic, LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

ELITE MULTI SPECIALTY CLINIC, LLC

Doing business as

Elite Multi Specialty Clinic, LLC

Practice address

12501 Prosperity Dr Ste 330
Silver Spring, MD 20904-1655

Phone

(301) 592-1780

Fax

(240) 645-4013

NPI assigned

Aug 12, 2020

Last updated

Aug 12, 2020By 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

Adaora Perpetua Noummy

Title

Office Admin

Phone

(301) 592-1780

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Elite Multi Specialty Clinic, LLC Doing business as

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

{
    "created_epoch": "1597190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597190400000",
    "number": "1699386789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12501 PROSPERITY DR STE 330",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209041655",
            "telephone_number": "301-592-1780",
            "fax_number": "240-645-4013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12501 PROSPERITY DR STE 330",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209041655",
            "telephone_number": "301-592-1780",
            "fax_number": "240-645-4013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE MULTI SPECIALTY CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-12",
        "last_updated": "2020-08-12",
        "certification_date": "2020-08-12",
        "status": "A",
        "authorized_official_last_name": "NOUMMY",
        "authorized_official_first_name": "ADAORA",
        "authorized_official_middle_name": "PERPETUA",
        "authorized_official_title_or_position": "OFFICE ADMIN",
        "authorized_official_telephone_number": "301-592-1780"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1053758235",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elite Multi Specialty Clinic, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Psychiatric/Mental Health Nurse Practitioner in Silver Spring, MD
• Providers in Silver Spring, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2020; 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.