MEDICARE: ELEVATE COMMUNITY HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1285409417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATE COMMUNITY HEALTH

Provider Business Mailing Address
First Line	:	24721 TOMBALL PARKWAY SUITE 160
Second Line	:
City	:	TOMBALL
State	:	TX
Zip	:	77375
Country	:	US
Telephone Number	:	281-540-0063
Fax Number	:

Provider Business Practice Location Address
First Line	:	24721 TOMBALL PARKWAY SUITE 160
Second Line	:
City	:	TOMBALL
State	:	TX
Zip	:	77375
Country	:	US
Telephone Number	:	281-440-5300
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	IVAN TARASENKO
Credential	:
Telephone Number	:	281-540-0063

Provider Enumeration Date	:	11/17/2023
Last Update Date	:	12/11/2025

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Directions to “ELEVATE COMMUNITY HEALTH ” Practice Location

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