=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922853753
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELEVATE MEDICAL CENTER, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2024
-----------------------------------------------------
Last Update Date | 04/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1002 W MAIN ST
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37087-4637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-444-2245
-----------------------------------------------------
Fax | 615-444-7656
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1002 W MAIN ST
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37087-4637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-444-2245
-----------------------------------------------------
Fax | 615-444-7656
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANAGER
-----------------------------------------------------
Name | CHRISTOPHER DON TOWNSEND
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 615-444-2245
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------