Organization
NORTHEAST ELITE MEDICAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAULETTE RUMPH FNP (CEO)
(803) 836-8679
Entity
Organization
Contact information
Practice address
136-4 FORUM DR, 1018, COLUMBIA, SC 29229
(803) 836-8679
(803) 800-2007
Mailing address
136-4 FORUM DR, 1018, COLUMBIA, SC 29229
(803) 836-8679
(803) 800-2007
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/09/2021
Last updated
06/09/2021
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