Provider Demographics
NPI:1720269020
Name:ALTITUDE FAMILY & INTERNAL MEDICINE, LLC
Entity Type:Organization
Organization Name:ALTITUDE FAMILY & INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-730-2167
Mailing Address - Street 1:13402 W COAL MINE AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-5407
Mailing Address - Country:US
Mailing Address - Phone:303-730-2167
Mailing Address - Fax:303-996-4820
Practice Address - Street 1:13402 W COAL MINE AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-5407
Practice Address - Country:US
Practice Address - Phone:303-730-2167
Practice Address - Fax:303-996-4820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB4616OtherMEDICARE PTAN