Healthcare Provider Details

I. General information

NPI: 1770963274
Provider Name (Legal Business Name): ELEVATE HEALTH GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W MAIN ST #206
BOISE ID
83702-7284
US

IV. Provider business mailing address

PO BOX 2193
BOISE ID
83701-2193
US

V. Phone/Fax

Practice location:
  • Phone: 208-426-9200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberNP-1093A
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberNP-1093A
License Number StateID

VIII. Authorized Official

Name: DR. CORY M SARTIN
Title or Position: CLINIC DIRECTOR
Credential:
Phone: 208-426-9200