Healthcare Provider Details

I. General information

NPI: 1659304863
Provider Name (Legal Business Name): ALTAPRO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5207 S STATE ST # 3
MURRAY UT
84107-4828
US

IV. Provider business mailing address

5207 S STATE ST # 3
MURRAY UT
84107-4828
US

V. Phone/Fax

Practice location:
  • Phone: 801-623-3855
  • Fax: 801-281-3386
Mailing address:
  • Phone: 801-623-3855
  • Fax: 801-281-3386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number58777921714
License Number StateUT

VIII. Authorized Official

Name: JASON HARRIS
Title or Position: PRESIDENT
Credential:
Phone: 801-281-2582