Healthcare Provider Details

I. General information

NPI: 1164350054
Provider Name (Legal Business Name): ALTEA MEDICAL ALABAMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 9TH ST NW
ALABASTER AL
35007-9179
US

IV. Provider business mailing address

400 E RIVULON BLVD STE 103
GILBERT AZ
85297-0096
US

V. Phone/Fax

Practice location:
  • Phone: 888-408-7008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA KRUEGER
Title or Position: VP OF RCM AND CONTRACTING
Credential:
Phone: 888-408-7008