Provider Demographics
NPI:1205334331
Name:ELEVATE MEDICAL INC.
Entity type:Organization
Organization Name:ELEVATE MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:C
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-501-0043
Mailing Address - Street 1:106 EAGLE ST
Mailing Address - Street 2:
Mailing Address - City:SENATOBIA
Mailing Address - State:MS
Mailing Address - Zip Code:38668-9501
Mailing Address - Country:US
Mailing Address - Phone:662-501-0043
Mailing Address - Fax:662-562-0161
Practice Address - Street 1:2349 VANDERBILT BEACH RD STE 508
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2776
Practice Address - Country:US
Practice Address - Phone:662-501-0043
Practice Address - Fax:662-562-0161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104322363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty