Healthcare Provider Details

I. General information

NPI: 1578472924
Provider Name (Legal Business Name): ELEVATE PRIME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10503 ENGELMANN AVE
SALIDA CO
81201-8015
US

IV. Provider business mailing address

10503 ENGELMANN AVE
SALIDA CO
81201-8015
US

V. Phone/Fax

Practice location:
  • Phone: 970-975-1275
  • Fax:
Mailing address:
  • Phone: 970-975-1275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHAD LEE
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 970-975-1275