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General NPI Number Information
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NPI Number | 1669053286
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Entity Type | Organization
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Legal Business Name | ELEVATION DIAGNOSTICS LLC
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Dates
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Enumeration Date | 04/15/2021
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 2115 SCRANTON ST STE 3040A
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City | AURORA
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State | CO
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Zip | 80045-7117
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Country | US
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Telephone | 800-440-5184
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Fax |
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Provider Business Mailing Address
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Address Line | 2115 SCRANTON ST STE 3040A
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City | AURORA
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State | CO
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Zip | 80045-7117
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Country | US
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Telephone | 800-440-5184
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Fax |
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Authorized Official
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Title or Position | MANAGING EMPLOYEE
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Name | MR. DYLAN JOHNSON
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Credential |
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Telephone | 720-240-6842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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