Provider Demographics
NPI:1194193433
Name:ALTUS URGENT CARE, LLC
Entity Type:Organization
Organization Name:ALTUS URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-379-0855
Mailing Address - Street 1:1015 E BROADWAY ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-5505
Mailing Address - Country:US
Mailing Address - Phone:580-379-0855
Mailing Address - Fax:580-379-0867
Practice Address - Street 1:1015 E BROADWAY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-5505
Practice Address - Country:US
Practice Address - Phone:580-379-0855
Practice Address - Fax:580-379-0867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18517261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care