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General NPI Number Information
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NPI Number | 1578961876
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Entity Type | Organization
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Legal Business Name | ALTITUDE HEMATOLOGY ONCOLOGY PC
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Dates
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Enumeration Date | 12/18/2014
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Last Update Date | 05/04/2015
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Provider Practice Location Address
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Address Line | 701 E HAMPDEN AVE ST. 540
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City | ENGLEWOOD
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State | CO
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Zip | 80113-2736
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Country | US
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Telephone | 720-317-2212
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Fax | 720-317-2216
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Provider Business Mailing Address
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Address Line | 701 E HAMPDEN AVE ST. 540
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City | ENGLEWOOD
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State | CO
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Zip | 80113-2736
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Country | US
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Telephone | 720-317-2212
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Fax | 720-317-2216
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. EDGAR F PRASTHOFER
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Credential | M.D.
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Telephone | 720-317-2212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 42668
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License Number State | CO
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