Provider Demographics
NPI:1184439150
Name:ELEMENTAL HEALTH HRT LLC
Entity type:Organization
Organization Name:ELEMENTAL HEALTH HRT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-389-7333
Mailing Address - Street 1:230 N 1680 E STE L1
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-2592
Mailing Address - Country:US
Mailing Address - Phone:435-414-7223
Mailing Address - Fax:
Practice Address - Street 1:230 N 1680 E STE L1
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2592
Practice Address - Country:US
Practice Address - Phone:435-414-7223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-07
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service