MEDICARE: ELEVATION SURGICAL ASSISTING, LLC

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	163WR0006X	Registered Nurse First Assistant	0129559	CO

General Provider Information

NPI Number	:	1376023838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATION SURGICAL ASSISTING, LLC

Provider Business Mailing Address
First Line	:	1470 ALMAGRE PEAK DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-3659
Country	:	US
Telephone Number	:	719-481-3028
Fax Number	:

Provider Business Practice Location Address
First Line	:	1470 ALMAGRE PEAK DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-3659
Country	:	US
Telephone Number	:	719-481-3028
Fax Number	:

Authorized Official
Title or Position	:	RNFA
Name	:	MR. PATRICK B FLEMING
Credential	:	RNFA
Telephone Number	:	719-481-3028

Provider Enumeration Date	:	08/15/2018
Last Update Date	:	08/15/2018

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