1649976051 NPI number — ELEVATE RECOVERY AND MEDSPA

Table of content: DR. JONATHAN MICHAEL TAGLIARENI D.D.S (NPI 1700182482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649976051 NPI number — ELEVATE RECOVERY AND MEDSPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELEVATE RECOVERY AND MEDSPA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649976051
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2801 S 88TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-885-8125
Provider Business Mailing Address Fax Number:
402-625-6047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ELEVATE RECOVERY AND MEDSPA
Provider Second Line Business Practice Location Address:
2801 S 88TH ST
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-885-8125
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2023

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
402-885-8125

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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