Provider Demographics
NPI:1356071708
Name:ALTUS DIRECT HEALTHCARE LLC
Entity Type:Organization
Organization Name:ALTUS DIRECT HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ABDIRAHIM
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:RASHID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-362-5000
Mailing Address - Street 1:3055 CLEVELAND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-3602
Mailing Address - Country:US
Mailing Address - Phone:614-525-0092
Mailing Address - Fax:614-525-0789
Practice Address - Street 1:3055 CLEVELAND AVE STE B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-3602
Practice Address - Country:US
Practice Address - Phone:614-525-0092
Practice Address - Fax:614-525-0789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty