Provider Demographics
NPI:1013571538
Name:ALTUS ER PHYSICIAN GROUP PLLC
Entity Type:Organization
Organization Name:ALTUS ER PHYSICIAN GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:IKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ILOCHONWU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-755-2273
Mailing Address - Street 1:137 N LHS DR STE 755
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-8620
Mailing Address - Country:US
Mailing Address - Phone:409-755-2273
Mailing Address - Fax:409-227-0531
Practice Address - Street 1:137 N LHS DR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-8620
Practice Address - Country:US
Practice Address - Phone:409-284-9717
Practice Address - Fax:409-227-0521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty