Provider Demographics
NPI:1578961876
Name:ALTITUDE HEMATOLOGY ONCOLOGY PC
Entity Type:Organization
Organization Name:ALTITUDE HEMATOLOGY ONCOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:F
Authorized Official - Last Name:PRASTHOFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-317-2212
Mailing Address - Street 1:701 E HAMPDEN AVE
Mailing Address - Street 2:ST. 540
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2736
Mailing Address - Country:US
Mailing Address - Phone:720-317-2212
Mailing Address - Fax:720-317-2216
Practice Address - Street 1:701 E HAMPDEN AVE
Practice Address - Street 2:ST. 540
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2736
Practice Address - Country:US
Practice Address - Phone:720-317-2212
Practice Address - Fax:720-317-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42668174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty