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ALTUS DIRECT LLC NPI 1750829230


NPI Information

NPI: 1750829230
Provider Name: ALTUS DIRECT, LLC

Doing Business As: SUPRO DIRECT

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 15D2126074

Address:
701 E COUNTY LINE RD
SUITE 210
GREENWOOD, IN
ZIP 46143
Phone: (317) 300-7424
Get Directions

ALTUS DIRECT, LLC is a family medicine in Greenwood, IN. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. ALTUS DIRECT, LLC NPI is 1750829230. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Supro Direct.

The provider's business location address is:

701 E COUNTY LINE RD
SUITE 210
GREENWOOD, IN
ZIP 46143-072
Phone: (317) 300-7424
Fax: (317) 360-7976

The provider's authorized official is Praveen Rajanahalli .
The authorized official title is Tin Owner and has the following contact phone number (317) 300-7424.

The CLIA number assigned to this NPI record is 15D2126074 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/6/2017 and was last updated on 10/9/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12084P0800XPsychiatry & NeurologyPsychiatryNo
2207Q00000XFamily MedicineYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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