Provider Demographics
NPI:1932909595
Name:ELEVATED LV MEDICAL GROUPS INC
Entity type:Organization
Organization Name:ELEVATED LV MEDICAL GROUPS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:PEACHES
Authorized Official - Middle Name:
Authorized Official - Last Name:DUON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:725-259-5787
Mailing Address - Street 1:5958 PIRATES DELIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6972
Mailing Address - Country:US
Mailing Address - Phone:725-259-5787
Mailing Address - Fax:
Practice Address - Street 1:2915 W CHARLESTON BLVD STE 180
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1903
Practice Address - Country:US
Practice Address - Phone:725-259-5787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-13
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty