Provider Demographics
NPI:1649722463
Name:ALTUS WAXAHACHIE, LP
Entity type:Organization
Organization Name:ALTUS WAXAHACHIE, LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-219-3833
Mailing Address - Street 1:1791 N HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-7868
Mailing Address - Country:US
Mailing Address - Phone:409-227-0531
Mailing Address - Fax:409-227-0521
Practice Address - Street 1:1791 N HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-7868
Practice Address - Country:US
Practice Address - Phone:409-227-0531
Practice Address - Fax:409-227-0521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care