Alta Wellness LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

ALTA WELLNESS LLC

Practice address

7959 Fredericksburg Rd
Suite 139
San Antonio, TX 78229-3430

Phone

(210) 615-3668

NPI assigned

Jan 7, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Willis Herald Wagner

Title

Owner

Phone

(210) 930-5505

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1199664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199664000000",
    "number": "1922283175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 ALTA AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782094432",
            "telephone_number": "210-930-5505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7959 FREDERICKSBURG RD",
            "address_2": "SUITE 139",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293430",
            "telephone_number": "210-615-3668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTA WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-07",
        "last_updated": "2008-01-07",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "WILLIS",
        "authorized_official_middle_name": "HERALD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-930-5505",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alta Physicians Management LLC
• Alta Vista Dentistry PLLC
• Alta Vista Healthcare Center
• Alta Vista Healthcare, LP
• Alta Wellness LLC
• Altacare Medical, Inc.
• Mohammed Basil Ibrahim Altaee, MD
• Ayssa Leigh Altahif, BCBA
• Sal S Altakali, DC
• Wualu Altamira, PH.D.

• Prosthetic/Orthotic Supplier in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Prosthetic/Orthotic Supplier in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2008; 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.