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General NPI Number Information
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NPI Number | 1760816417
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Entity Type | Organization
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Legal Business Name | ELEVATION INTERNAL MEDICINE PC
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Dates
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Enumeration Date | 08/29/2013
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Last Update Date | 08/29/2013
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Provider Practice Location Address
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Address Line | 1501 E 3RD ST
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City | DELTA
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State | CO
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Zip | 81416-2815
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Country | US
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Telephone | 970-874-7681
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1112
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City | DURANGO
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State | CO
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Zip | 81302-1112
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Country | US
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Telephone | 702-453-3799
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Fax | 702-453-5741
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Authorized Official
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Title or Position | ACCTS MGR
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Name | LORI LABRECQUE
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Credential |
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Telephone | 702-453-3799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | DR0044007
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License Number State | CO
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