Healthcare Provider Details

I. General information

NPI: 1740823178
Provider Name (Legal Business Name): ALTAIR INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9812 POKAI WAY
DIAMONDHEAD MS
39525-4342
US

IV. Provider business mailing address

9812 POKAI WAY
DIAMONDHEAD MS
39525-4342
US

V. Phone/Fax

Practice location:
  • Phone: 228-222-4354
  • Fax:
Mailing address:
  • Phone: 228-222-4354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT BAUMANN
Title or Position: OWNER
Credential:
Phone: 228-222-4354