Altavista Healthcare Group, LLC

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

Legal business name

ALTAVISTA HEALTHCARE GROUP, LLC

Practice address

154 E Myrtle Ave Ste 100
Murray, UT 84107-4850

Phone

(210) 249-4949

NPI assigned

Sep 12, 2018

Last updated

Sep 12, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Blanca Corrie

Title

Ceo

Phone

(210) 249-4949

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1536710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536710400000",
    "number": "1699258954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14439 NW MILITARY HWY STE 449",
            "city": "SHAVANO PARK",
            "state": "TX",
            "postal_code": "782311646",
            "telephone_number": "210-249-4949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "154 E MYRTLE AVE STE 100",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841074850",
            "telephone_number": "210-249-4949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTAVISTA HEALTHCARE GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-12",
        "last_updated": "2018-09-12",
        "status": "A",
        "authorized_official_last_name": "CORRIE",
        "authorized_official_first_name": "BLANCA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "210-249-4949"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Rehabilitation Clinic/Center in Murray, UT
• Providers in Murray, UT by specialty
• Rehabilitation Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.