Provider Demographics
NPI:1982049953
Name:ELEVATION HEALTH TEXARKANA LLC
Entity Type:Organization
Organization Name:ELEVATION HEALTH TEXARKANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-710-4868
Mailing Address - Street 1:7948 DAVIS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-6954
Mailing Address - Country:US
Mailing Address - Phone:817-697-2560
Mailing Address - Fax:
Practice Address - Street 1:3325 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-0707
Practice Address - Country:US
Practice Address - Phone:903-223-8776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEXAGON HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-05
Last Update Date:2013-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty