Provider Demographics
NPI:1659304863
Name:ALTAPRO INC.
Entity Type:Organization
Organization Name:ALTAPRO INC.
Other - Org Name:ALTAPRO MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-281-2582
Mailing Address - Street 1:5207 S STATE ST
Mailing Address - Street 2:# 3
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-4828
Mailing Address - Country:US
Mailing Address - Phone:801-623-3855
Mailing Address - Fax:801-281-3386
Practice Address - Street 1:5207 S STATE ST
Practice Address - Street 2:# 3
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-4828
Practice Address - Country:US
Practice Address - Phone:801-623-3855
Practice Address - Fax:801-281-3386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT58777921714332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid
UT=========001Medicaid