Provider Demographics
NPI:1013433762
Name:ELEVATING CARE CLINIC, LLC
Entity Type:Organization
Organization Name:ELEVATING CARE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MOSBY-PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:816-665-6124
Mailing Address - Street 1:PO BOX 18447
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-8447
Mailing Address - Country:US
Mailing Address - Phone:816-674-5903
Mailing Address - Fax:
Practice Address - Street 1:2340 E. MEYER BLVD
Practice Address - Street 2:208
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1105
Practice Address - Country:US
Practice Address - Phone:816-665-6124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017000664261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty