Provider Demographics
NPI:1871946236
Name:ELITE HEALTHCARE AND WELLNESS GROUP, INC
Entity type:Organization
Organization Name:ELITE HEALTHCARE AND WELLNESS GROUP, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JT
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWITT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:239-631-6529
Mailing Address - Street 1:2430 VANDERBILT BEACH RD
Mailing Address - Street 2:SUITE 108-345
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-2654
Mailing Address - Country:US
Mailing Address - Phone:239-631-6529
Mailing Address - Fax:239-631-6720
Practice Address - Street 1:2400 VANDERBILT BEACH RD
Practice Address - Street 2:SUITE 106
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2771
Practice Address - Country:US
Practice Address - Phone:239-631-6529
Practice Address - Fax:239-631-6720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty