MEDICARE: ALTAMEDIX CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306051032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTAMEDIX CORPORATION

Provider Business Mailing Address
First Line	:	4234 N FREEWAY BLVD
Second Line	:	SUITE 500
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-1237
Country	:	US
Telephone Number	:	916-648-3999
Fax Number	:	916-648-1919

Provider Business Practice Location Address
First Line	:	4234 N FREEWAY BLVD
Second Line	:	SUITE 500
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-1237
Country	:	US
Telephone Number	:	916-648-3999
Fax Number	:	916-648-1919

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. MIRON BALYASNY
Credential	:
Telephone Number	:	916-648-3999

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	08/22/2020

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Directions to “ALTAMEDIX CORPORATION ” Practice Location

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