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General NPI Number Information
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NPI Number | 1598011306
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Entity Type | Organization
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Legal Business Name | ALTA VISTA CENTER FOR INTEGRATIVE MEDICINE, LLC
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Dates
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Enumeration Date | 07/30/2012
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Last Update Date | 07/30/2012
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Provider Practice Location Address
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Address Line | 313 S 2ND ST SUITE B
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City | LARAMIE
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State | WY
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Zip | 82070-3611
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Country | US
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Telephone | 307-399-3119
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Fax | 866-827-3930
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Provider Business Mailing Address
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Address Line | 313 S 2ND ST SUITE B
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City | LARAMIE
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State | WY
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Zip | 82070-3611
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Country | US
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Telephone | 307-399-3119
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Fax | 866-827-3930
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Authorized Official
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Title or Position | CEO/MEDICAL DIRECTOR
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Name | DR. WILLIAM S. FITTERMAN
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Credential | D.O.
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Telephone | 307-399-3119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 7766A
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 7766A
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License Number State | WY
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