1578961876 NPI number — ALTITUDE HEMATOLOGY ONCOLOGY PC

Table of content: (NPI 1578961876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578961876 NPI number — ALTITUDE HEMATOLOGY ONCOLOGY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALTITUDE HEMATOLOGY ONCOLOGY PC
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:
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NPI Number Information

NPI Number:
1578961876
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 E HAMPDEN AVE
Provider Second Line Business Mailing Address:
ST. 540
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80113-2736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-317-2212
Provider Business Mailing Address Fax Number:
720-317-2216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 E HAMPDEN AVE
Provider Second Line Business Practice Location Address:
ST. 540
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80113-2736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-317-2212
Provider Business Practice Location Address Fax Number:
720-317-2216
Provider Enumeration Date:
12/18/2014

Additional Information

Authorized Official

Authorized Official Last Name:
PRASTHOFER
Authorized Official First Name:
EDGAR
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
720-317-2212

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  42668 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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