Healthcare Provider Details

I. General information

NPI: 1376023838
Provider Name (Legal Business Name): ELEVATION SURGICAL ASSISTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 ALMAGRE PEAK DR
COLORADO SPRINGS CO
80921-3659
US

IV. Provider business mailing address

1470 ALMAGRE PEAK DR
COLORADO SPRINGS CO
80921-3659
US

V. Phone/Fax

Practice location:
  • Phone: 719-481-3028
  • Fax:
Mailing address:
  • Phone: 719-481-3028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number0129559
License Number StateCO

VIII. Authorized Official

Name: MR. PATRICK B FLEMING
Title or Position: RNFA
Credential: RNFA
Phone: 719-481-3028