Provider Demographics
NPI:1366945354
Name:HIGH ALTITUDE MOBILE PHYSICIANS
Entity type:Organization
Organization Name:HIGH ALTITUDE MOBILE PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOOK
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:970-389-7999
Mailing Address - Street 1:305 S RIDGE ST UNIT 3488
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424-9136
Mailing Address - Country:US
Mailing Address - Phone:970-389-7999
Mailing Address - Fax:
Practice Address - Street 1:305 S RIDGE ST UNIT 3488
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:CO
Practice Address - Zip Code:80424-9136
Practice Address - Country:US
Practice Address - Phone:970-389-7999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health