Provider Demographics
NPI:1114198827
Name:ALTRA MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ALTRA MEDICAL CORPORATION
Other - Org Name:ALTRA MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:O
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-541-5900
Mailing Address - Street 1:9743 SAGO POINT DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-4903
Mailing Address - Country:US
Mailing Address - Phone:727-541-5900
Mailing Address - Fax:727-541-5990
Practice Address - Street 1:9105 BELCHER RD
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-4429
Practice Address - Country:US
Practice Address - Phone:727-541-5900
Practice Address - Fax:727-541-5990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies