Healthcare Provider Details

I. General information

NPI: 1255935706
Provider Name (Legal Business Name): ALTIUS MANAGEMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14221 SW 120TH ST STE 129A
MIAMI FL
33186-7463
US

IV. Provider business mailing address

14221 SW 120TH ST STE 101
MIAMI FL
33186-7291
US

V. Phone/Fax

Practice location:
  • Phone: 305-988-5000
  • Fax:
Mailing address:
  • Phone: 305-988-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LUIS O MONTEAGUDO
Title or Position: PRESIDENT
Credential: PA
Phone: 305-988-5000