Provider Demographics
NPI:1790179398
Name:ELEV MEDICAL CENTER, PLLC
Entity Type:Organization
Organization Name:ELEV MEDICAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:QUINTAVELL
Authorized Official - Last Name:RADCLIFFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-848-0444
Mailing Address - Street 1:201 ENTERPRISE AVE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3082
Mailing Address - Country:US
Mailing Address - Phone:832-848-0444
Mailing Address - Fax:
Practice Address - Street 1:201 ENTERPRISE AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3082
Practice Address - Country:US
Practice Address - Phone:832-848-0444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1391207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty