Provider Demographics
NPI:1407231483
Name:ALTIUS DIAGNOSTICS LABORATORY LLC
Entity Type:Organization
Organization Name:ALTIUS DIAGNOSTICS LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-341-4818
Mailing Address - Street 1:12100 NORTHUP WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1920
Mailing Address - Country:US
Mailing Address - Phone:425-341-4818
Mailing Address - Fax:425-296-1355
Practice Address - Street 1:12100 NORTHUP WAY
Practice Address - Street 2:SUITE A
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1920
Practice Address - Country:US
Practice Address - Phone:425-341-4818
Practice Address - Fax:425-296-1355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory