Provider Demographics
NPI:1740771211
Name:ELEVATION EP, LLC
Entity Type:Organization
Organization Name:ELEVATION EP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-368-1980
Mailing Address - Street 1:201 MAIN STREET
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FT. WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-3105
Mailing Address - Country:US
Mailing Address - Phone:817-270-0384
Mailing Address - Fax:817-270-0384
Practice Address - Street 1:201 MAIN STREET
Practice Address - Street 2:SUITE 600
Practice Address - City:FT. WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-3105
Practice Address - Country:US
Practice Address - Phone:817-270-0384
Practice Address - Fax:817-270-0384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty