| Northeast Elite Medical Clinic, Llc | |
|
136-4 Forum Dr 1018 Columbia SC 29229 | |
| (803) 836-8679 | |
| (803) 800-2007 |
| Full Name | Northeast Elite Medical Clinic, Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 136-4 Forum Dr, Columbia, South Carolina |
| Authorized Official Name and Position | Paulette Rumph (CEO) |
| Authorized Official Contact | 8038368679 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northeast Elite Medical Clinic, Llc 136-4 Forum Dr 1018 Columbia SC 29229 Ph: (803) 836-8679 | Northeast Elite Medical Clinic, Llc 136-4 Forum Dr 1018 Columbia SC 29229 Ph: (803) 836-8679 |
| NPI Number | 1497322325 |
|---|---|
| Provider Enumeration Date | 06/09/2021 |
| Last Update Date | 06/09/2021 |
| Medicare PECOS PAC ID | 6507252186 |
|---|---|
| Medicare Enrollment ID | O20220407001086 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497322325 | NPI | - | NPPES |
| Provider Name | Paulette O'neal Rumph |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356821904 PECOS PAC ID: 4284987587 Enrollment ID: I20181105000440 |
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