Provider Demographics
NPI:1558554113
Name:ALTITUDE ANALYSIS, INC
Entity Type:Organization
Organization Name:ALTITUDE ANALYSIS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:DEL SOCORRO
Authorized Official - Last Name:STRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CLS
Authorized Official - Phone:307-362-4552
Mailing Address - Street 1:2528 FOOTHILL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-4745
Mailing Address - Country:US
Mailing Address - Phone:307-362-4552
Mailing Address - Fax:307-362-4553
Practice Address - Street 1:2528 FOOTHILL BLVD STE A
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-4745
Practice Address - Country:US
Practice Address - Phone:307-362-4552
Practice Address - Fax:307-362-4553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY20636Medicare PIN