Healthcare Provider Details

I. General information

NPI: 1013364330
Provider Name (Legal Business Name): ELEVATION MEDICAL SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 TALAMINE CT
COLORADO SPRINGS CO
80907-5176
US

IV. Provider business mailing address

140 TALAMINE CT
COLORADO SPRINGS CO
80907-5176
US

V. Phone/Fax

Practice location:
  • Phone: 719-473-8464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMIE HOUSE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 719-473-8464