Provider Demographics
NPI:1720590672
Name:ELEVATED ANESTHESIA LLC
Entity Type:Organization
Organization Name:ELEVATED ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:FORDYCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-853-4444
Mailing Address - Street 1:560 N SWITZER CANYON DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-4844
Mailing Address - Country:US
Mailing Address - Phone:928-774-3044
Mailing Address - Fax:928-774-7107
Practice Address - Street 1:560 N SWITZER CANYON DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4844
Practice Address - Country:US
Practice Address - Phone:928-774-3044
Practice Address - Fax:928-774-7107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty