Provider Demographics
NPI:1306461447
Name:ELEVATE MEDICAL FORT MYERS, LLC
Entity type:Organization
Organization Name:ELEVATE MEDICAL FORT MYERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:870-919-6686
Mailing Address - Street 1:1850 BOY SCOUT DR STE A102
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2127
Mailing Address - Country:US
Mailing Address - Phone:662-501-0043
Mailing Address - Fax:662-560-0161
Practice Address - Street 1:1850 BOY SCOUT DR STE A102
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2127
Practice Address - Country:US
Practice Address - Phone:870-919-6686
Practice Address - Fax:662-560-0161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty