MEDICARE: ALTUS ALLERGY

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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1710205612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTUS ALLERGY

Provider Business Mailing Address
First Line	:	4265 SAN FELIPE ST STE 1100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-2998
Country	:	US
Telephone Number	:	409-795-9560
Fax Number	:	713-960-6691

Provider Business Practice Location Address
First Line	:	4265 SAN FELIPE ST STE 1100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-2998
Country	:	US
Telephone Number	:	409-795-9560
Fax Number	:	713-960-6691

Authorized Official
Title or Position	:	DIRECTOR OF OPERATION
Name	:	TIFFANY M GRAVES
Credential	:
Telephone Number	:	409-795-9560

Provider Enumeration Date	:	05/17/2010
Last Update Date	:	05/17/2010

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Directions to “ALTUS ALLERGY ” Practice Location

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