Provider Demographics
NPI:1205559200
Name:LATITUDE MEDICAL LLC
Entity type:Organization
Organization Name:LATITUDE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:T
Authorized Official - Last Name:LILJEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-238-8716
Mailing Address - Street 1:105 MOUNTAIN BROOK LN
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-4649
Mailing Address - Country:US
Mailing Address - Phone:828-238-8716
Mailing Address - Fax:
Practice Address - Street 1:1320 HIGHWAY 231 S STE 4
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-3000
Practice Address - Country:US
Practice Address - Phone:828-238-8716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-23
Last Update Date:2024-09-11
Deactivation Date:2024-01-31
Deactivation Code:
Reactivation Date:2024-09-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies