Provider Demographics
NPI:1730710229
Name:ALTAIRE CLINIC PLLC
Entity type:Organization
Organization Name:ALTAIRE CLINIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHUE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:701-388-6306
Mailing Address - Street 1:5257 27TH ST S STE 201
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7782
Mailing Address - Country:US
Mailing Address - Phone:701-356-5503
Mailing Address - Fax:
Practice Address - Street 1:5257 27TH ST S STE 201
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7782
Practice Address - Country:US
Practice Address - Phone:701-356-5503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-03
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty