Provider Demographics
NPI:1710084926
Name:ALTA PHYSICIANS MANAGEMENT LLC
Entity Type:Organization
Organization Name:ALTA PHYSICIANS MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTAKALI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:210-222-0999
Mailing Address - Street 1:322 S FLORES ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78204-1106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:322 S FLORES ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78204-1106
Practice Address - Country:US
Practice Address - Phone:210-222-0999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF006458111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0031JWOtherBLUECROSS/BLUE SHIELD
TX174577001Medicaid
TX00422YMedicare PIN