Provider Demographics
NPI:1649942897
Name:WELEVATE FOR PAIN A MEDICAL CORP
Entity type:Organization
Organization Name:WELEVATE FOR PAIN A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-473-4809
Mailing Address - Street 1:45210 CLUB DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN WELLS
Mailing Address - State:CA
Mailing Address - Zip Code:92210-8860
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45210 CLUB DR
Practice Address - Street 2:
Practice Address - City:INDIAN WELLS
Practice Address - State:CA
Practice Address - Zip Code:92210-8860
Practice Address - Country:US
Practice Address - Phone:914-758-0044
Practice Address - Fax:914-533-3568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center