Provider Demographics
NPI:1700133303
Name:ALTA HEALTH GROUP LLC
Entity Type:Organization
Organization Name:ALTA HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER - CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:GIPP
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-434-6000
Mailing Address - Street 1:9010 STRADA STELL CT
Mailing Address - Street 2:SUITE 107
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-4424
Mailing Address - Country:US
Mailing Address - Phone:239-434-6000
Mailing Address - Fax:
Practice Address - Street 1:7385 RADIO RD
Practice Address - Street 2:SUITE 104
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-6704
Practice Address - Country:US
Practice Address - Phone:239-434-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALTA PRIVATE HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty