| Elevation Health Llc | |
|
1745 W 33rd St Edmond OK 73013-3831 | |
| (406) 309-4780 | |
| Not Available |
| Full Name | Elevation Health Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1745 W 33rd St, Edmond, Oklahoma |
| Authorized Official Name and Position | Charles Tate Woodward (PHYSICIAN/OWNER) |
| Authorized Official Contact | 4063094780 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elevation Health Llc 1745 W 33rd St Edmond OK 73013-3831 Ph: (406) 309-4780 | Elevation Health Llc 1745 W 33rd St Edmond OK 73013-3831 Ph: (406) 309-4780 |
| NPI Number | 1841077807 |
|---|---|
| Provider Enumeration Date | 09/13/2023 |
| Last Update Date | 10/04/2024 |
| Certification Date | 10/04/2024 |
| Medicare PECOS PAC ID | 4486098019 |
|---|---|
| Medicare Enrollment ID | O20240222000163 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841077807 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Charles Tate Woodward |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760606917 PECOS PAC ID: 5395839294 Enrollment ID: I20190130002827 |
| Provider Name | Rakesh Amin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437445475 PECOS PAC ID: 6002050010 Enrollment ID: I20210827000396 |
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