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ALTAIRE CLINIC PLLC NPI 1730710229


NPI Information

NPI: 1730710229
Provider Name: ALTAIRE CLINIC PLLC

Former Legal Business Name: LASER RENEWAL PLLC

Classification: Dermatology - 207NS0135X
Entity Type: Organization

Specialization: Procedural Dermatology

CLIA Number: 35D2223957

Address:
5257 27TH ST S STE 201
FARGO, ND
ZIP 58104
Phone: (701) 356-5503
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ALTAIRE CLINIC PLLC is a procedural dermatology dermatology in Fargo, ND. The provider is procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue for health or cosmetic benefit. These methods include scalpel surgery, laser surgery, chemical surgery, cryosurgery (liquid nitrogen), electrosurgery, aspiration surgery, liposuction, injection of filler substances, and Mohs micrographic controlled surgery (a special technique for the removal of growths, especially skin cancers). ALTAIRE CLINIC PLLC NPI is 1730710229. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Former Legal Business Name Is Laser Renewal Pllc.

The provider's business location address is:

5257 27TH ST S STE 201
FARGO, ND
ZIP 58104-782
Phone: (701) 356-5503

The provider's authorized official is Tamra A Schue .
The authorized official title is Owner and has the following contact phone number (701) 388-6306.

The CLIA number assigned to this NPI record is 35D2223957 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/3/2020 and was last updated on 12/7/2021.


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
1207NS0135XDermatologyProcedural DermatologyYes

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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