Provider Demographics
NPI:1356776959
Name:ALTUS LUMBERTON, LP
Entity type:Organization
Organization Name:ALTUS LUMBERTON, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-981-5580
Mailing Address - Street 1:137 N LHS DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-8620
Mailing Address - Country:US
Mailing Address - Phone:409-981-5580
Mailing Address - Fax:408-981-5501
Practice Address - Street 1:137 N LHS DR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-8620
Practice Address - Country:US
Practice Address - Phone:409-981-5580
Practice Address - Fax:408-981-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-13
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX160177261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care