Provider Demographics
NPI:1275957508
Name:ALTUS LAKE JACKSON, LP
Entity Type:Organization
Organization Name:ALTUS LAKE JACKSON, LP
Other - Org Name:ALTUS MANAGEMENT LLC GEN PTR
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-219-3833
Mailing Address - Street 1:1535 WEST LOOP S
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-9512
Mailing Address - Country:US
Mailing Address - Phone:832-219-3833
Mailing Address - Fax:
Practice Address - Street 1:200 OAK DRIVE SOUTH
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5628
Practice Address - Country:US
Practice Address - Phone:409-981-5580
Practice Address - Fax:409-981-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care