Leo Altamirano, M.D.
Individual provider Active NPI Pediatrics Physician · Garden City, KS
NPI 1184677403 · NPPES record last updated Jan 16, 2012
Key facts
- NPI
- 1184677403
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 04-34459 (KS)
- Practice address
- 311 E Spruce St
Garden City, KS 67846 - Phone
- (620) 275-3700
- NPI assigned
- May 18, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180424001251 | KS | Practitioner - Pediatric Medicine | 5698771350 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04-34459 | KS | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Commonspirit Kansas, Inc. | Current | Accepting new patients | |
| Commonspirit Kansas, Inc. | Pediatrics | Current |
Accepting new patients |
| St Catherine Hospital | Pediatrics | Current |
Accepting new patients |
| St. Catherine Hospital | Pediatrics | Past | Accepting new patients |
Locations
100 W Ross Blvd
Ste 1B
Dodge City, KS 67801
Phone (620) 371-5576
311 E Spruce St
Garden City, KS 67846
Phone (620) 271-3139
401 E Spruce St
Garden City, KS 67846
Phone (620) 272-2222
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 04-34459 | KS | Yes |
Addresses
Primary practice location
311 E Spruce St
Garden City, KS 67846
Mailing address
311 E Spruce St
Garden City, KS 67846
Phone (620) 275-3700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200657740A | Medicaid | KS | |
| 04-34459 | Other | KS | KS LICENSE |
Other providers in Garden City, KS
- Amina Shukri Ahmed
- J. Lynette Alexander
- Melanie Ann Algrim
- Jennifer Brooke Allen
- Allstate Healthcare Services Inc
- Terry Anderson
- Andrea'S Counseling, PLLC
- Tarryn Kay Andrews
- Anesthesia Associates of Southwest Kansas LLC
- Anita Motto LLC
All providers in Garden City, KS · Pediatrics Physician in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 16, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.