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NPI Code Detail

MEDICARE: ALTUS MINOR EMERGENCY & FAMILY PRACTICE

MEDICARE: ALTUS MINOR EMERGENCY & FAMILY PRACTICE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1659738953
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALTUS MINOR EMERGENCY & FAMILY PRACTICE
Provider Business Mailing Address
First Line : 916 N MAIN ST
Second Line :
City : ALTUS
State : OK
Zip : 73521-3118
Country : US
Telephone Number : 580-318-0229
Fax Number : 580-480-0044
Provider Business Practice Location Address
First Line : 916 N MAIN ST
Second Line :
City : ALTUS
State : OK
Zip : 73521-3118
Country : US
Telephone Number : 580-318-0229
Fax Number : 580-480-0044
Authorized Official
Title or Position : OWNER
Name : MS. BRIDGET MOSS
Credential : APRN
Telephone Number : 580-318-0229
Provider Enumeration Date : 01/19/2016
Last Update Date : 03/02/2016

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Directions to “ALTUS MINOR EMERGENCY & FAMILY PRACTICE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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