Provider Demographics
NPI:1043859507
Name:ALTITUDE DIALYSIS INC.
Entity type:Organization
Organization Name:ALTITUDE DIALYSIS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADD
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-445-8265
Mailing Address - Street 1:1209 MONROE STREET
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-3445
Mailing Address - Country:US
Mailing Address - Phone:970-445-8265
Mailing Address - Fax:970-445-8265
Practice Address - Street 1:1209 MONROE STREET
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-3445
Practice Address - Country:US
Practice Address - Phone:970-445-8265
Practice Address - Fax:970-445-8265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment