MEDICARE: ELEVATE SURGICAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1952064198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATE SURGICAL PC

Provider Business Mailing Address
First Line	:	425 E 5350 S STE 205
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84405-6901
Country	:	US
Telephone Number	:	801-540-9556
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 E 5350 S STE 205
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84405-6901
Country	:	US
Telephone Number	:	801-540-9556
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THOMAS CALTON
Credential	:	MD
Telephone Number	:	801-540-9556

Provider Enumeration Date	:	10/14/2021
Last Update Date	:	11/11/2021

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Directions to “ELEVATE SURGICAL PC ” Practice Location

Language	Start Address	Practice Location

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